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A randomized, double-blind trial evaluating the efficacy of palonosetron with total intravenous anesthesia using propofol and remifentanil for the prevention of postoperative nausea and vomiting after gynecologic surgery

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Abstract

Purpose

Palonosetron has potent and long-acting antiemetic effects for postoperative nausea and vomiting (PONV). The aim of this study was to prospectively evaluate the efficacy of palonosetron when used with total intravenous anesthesia (TIVA) using propofol and remifentanil for the prevention of PONV in patients undergoing laparoscopic gynecologic surgery.

Methods

This prospective double-blind study comprised 100 female American Society of Anesthesiologist physical status I and II patients who were undergoing laparoscopic gynecologic surgery under TIVA. The patients were randomly assigned to two groups—the palonosetron plus TIVA group (palonosetron 0.075 mg i.v., n = 50) and the TIVA group (normal saline 1.5 ml i.v., n = 50). The treatments were given before the induction of anesthesia. The incidence of PONV, severity, number of rescue antiemetics, adverse effects, and patient satisfaction during the first 24 h after surgery were evaluated.

Results

The demographic profiles of the patients in the two groups were comparable. The overall incidence of PONV (0–24 h) was significantly lower in the TIVA plus palonosetron group than in the TIVA group (34 vs 58 %, p = 0.027). In particular, during the 6–24 h after surgery, the incidence of PONV (14 vs 30 %, p = 0.03) and the incidence of moderate to severe nausea (6 vs 22 %, p = 0.041) were significantly lower in the TIVA plus palonosetron group than in the TIVA group. There were no significant differences in adverse effects, use of rescue antiemetics or patient satisfaction.

Conclusion

Combining palonosetron with TIVA can be considered as a good method to prevent PONV, not only during the short postoperative period but also especially during the 6–24-h period after anesthesia.

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References

  1. Muchatuta NA, Paech MJ. Management of postoperative nausea and vomiting: focus on palonosetron. Ther Clin Risk Manag. 2009;5:21–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700.

    Article  CAS  PubMed  Google Scholar 

  3. Moon YE. Postoperative nausea and vomiting. Korean J Anesthesiol. 2014;67:164–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Curr Opin Anaesthesiol. 2006;19:606–11.

    Article  PubMed  Google Scholar 

  5. Xiong C, Liu G, Ma R, Xue J, Wu A. Efficacy of palonosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis. Can J Anaesth. 2015;62:1268–78.

    Article  PubMed  Google Scholar 

  6. Stoltz R, Cyong JC, Shah A, Parisi S. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects. J Clin Pharmacol. 2004;44:520–31.

    Article  CAS  PubMed  Google Scholar 

  7. Wong EH, Clark R, Leung E, Loury D, Bonhaus DW, Jakeman L, Parnes H, Whiting RL, Eglen RM. The interaction of RS 25259-197, a potent and selective antagonist, with 5-HT3 receptors, in vitro. Br J Pharmacol. 1995;114:851–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. White H, Black RJ, Jones M. Mar Fan GC. Randomized comparison of two anti-emetic strategies in high-risk patients undergoing day-case gynaecological surgery. Br J Anaesth. 2007;98:470–6.

    Article  CAS  PubMed  Google Scholar 

  9. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77:162–84.

    Article  CAS  PubMed  Google Scholar 

  10. Choi DK, Chin JH, Lee EH, Lim OB, Chung CH, Ro YJ, Choi IC. Prophylactic control of post-operative nausea and vomiting using ondansetron and ramosetron after cardiac surgery. Acta Anaesthesiol Scand. 2010;54:962–9.

    Article  CAS  PubMed  Google Scholar 

  11. Park SK, Cho EJ. A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery. J Int Med Res. 2011;39:399–407.

    Article  CAS  PubMed  Google Scholar 

  12. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Jokela RM, Cakmakkaya OS, Danzeisen O, Korttila KT, Kranke P, Malhotra A, Paura A, Radke OC, Sessler DI, Soikkeli A, Roewer N, Apfel CC. Ondansetron has similar clinical efficacy against both nausea and vomiting. Anaesthesia. 2009;64:147–51.

    Article  CAS  PubMed  Google Scholar 

  14. Rojas C, Li Y, Zhang J, Stathis M, Alt J, Thomas AG, Cantoreggi S, Sebastiani S, Pietra C, Slusher BS. The antiemetic 5-HT3 receptor antagonist palonosetron inhibits substance P-mediated responses in vitro and in vivo. J Pharmacol Exp Ther. 2010;335:362–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Rojas C, Thomas AG, Alt J, Stathis M, Zhang J, Rubenstein EB, Sebastiani S, Cantoreggi S, Slusher BS. Palonosetron triggers 5-HT(3) receptor internalization and causes prolonged inhibition of receptor function. Eur J Pharmacol. 2010;626:193–9.

    Article  CAS  PubMed  Google Scholar 

  16. Kim HJ, Lee HC, Jung YS, Lee J, Min JJ, Hong DM, Choi EK, Oh S, Jeon Y. Effect of palonosetron on the QTc interval in patients undergoing sevoflurane anaesthesia. Br J Anaesth. 2014;112:460–8.

    Article  CAS  PubMed  Google Scholar 

  17. Candiotti KA, Kovac AL, Melson TI, Clerici G, Joo Gan T. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo for preventing postoperative nausea and vomiting. Anesth Analg. 2008;107:445–51.

    Article  CAS  PubMed  Google Scholar 

  18. Kovac AL, Eberhart L, Kotarski J, Clerici G, Apfel C. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a 72 h period. Anesth Analg. 2008;107:439–44.

    Article  CAS  PubMed  Google Scholar 

  19. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, Heineck R, Greim CA, Roewer N. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88:659–68.

    Article  CAS  PubMed  Google Scholar 

  20. Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 1998;15:433–45.

    Article  CAS  PubMed  Google Scholar 

  21. Tramer M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth. 1997;78:247–55.

    Article  CAS  PubMed  Google Scholar 

  22. Tricco AC, Soobiah C, Blondal E, Veroniki AA, Khan PA, Vafaei A, Ivory J, Strifler L, Ashoor H, MacDonald H, Reynen E, Robson R, Ho J, Ng C, Antony J, Mrklas K, Hutton B, Hemmelgarn BR, Moher D, Straus SE. Comparative efficacy of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis. BMC Med. 2015;13:136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lee WS, Lee KB, Lim S, Chang YG. Comparison of palonosetron, granisetron, and ramosetron for the prevention of postoperative nausea and vomiting after laparoscopic gynecologic surgery: a prospective randomized trial. BMC Anesthesiol. 2015;15:121.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Scuderi PE, James RL, Harris L, Mims GR 3rd. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg. 2000;91:1408–14.

    Article  CAS  PubMed  Google Scholar 

  25. Leslie JB, Gan TJ. Meta-analysis of the safety of 5-HT3 antagonists with dexamethasone or droperidol for prevention of PONV. Ann Pharmacother. 2006;40:856–72.

    Article  CAS  PubMed  Google Scholar 

  26. Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand. 2002;46:921–8.

    Article  CAS  PubMed  Google Scholar 

  27. Breivik EK, Bjornsson GA, Skovlund E. A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain. 2000;16:22–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

YSB contributed to data collection and manuscript drafting. YUK contributed to statistical review. EYS assisted in study design. YSB, SKP and DWO helped manage and care for the patients. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea

    Yun-Sic Bang & Young Uk Kim

  2. Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keun Jaebong Road, Hwaseong, Gyeonggi, Korea

    Dawoon Oh, Eui Yong Shin & Soo Kyoung Park

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  1. Yun-Sic Bang
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  2. Young Uk Kim
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Correspondence to Soo Kyoung Park.

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Bang, YS., Kim, Y.U., Oh, D. et al. A randomized, double-blind trial evaluating the efficacy of palonosetron with total intravenous anesthesia using propofol and remifentanil for the prevention of postoperative nausea and vomiting after gynecologic surgery. J Anesth 30, 935–940 (2016). https://doi.org/10.1007/s00540-016-2249-3

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  • DOI: https://doi.org/10.1007/s00540-016-2249-3

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