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Palonosetron Versus Ramosetron Prophylaxis for Control of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia

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Abstract

Purpose

Postoperative nausea and vomiting (PONV) after spinal anesthesia for cesarean delivery are distressing to both patients and surgeons. This study was designed to evaluate the efficacy and safety of palonosetron and ramosetron (both newer and highly potent 5HT3 receptor antagonists) in nausea and vomiting in cesarean delivery after spinal anesthesia.

Methods

In this randomized, double-blind study, 109 women received either palonosetron (0.075 mg) or ramosetron (0.3 mg) intravenously immediately after clamping of the fetal umbilical cord. Nausea, vomiting, adverse events, and overall satisfaction were then observed for 48 h after administration of spinal anesthesia.

Results

A complete response (defined as no postoperative nausea and vomiting) during first 0–2 h postoperative after administration of spinal anesthesia was achieved in 85.5 % of patients with palonosetron and in 83.3 % of patients with ramosetron (p > 0.05). However, the corresponding incidence during 2 to 24 h was 70.9 and 53.7 %, respectively (p < 0.05), while it was 63.3 and 44.4 % at 24–48 h after anesthesia (p < 0.05). Along with a more complete response, the severity of nausea was also lesser with palonosetron during the corresponding study periods (2–24 and 24–48 h, respectively; p < 0.05). Patients who received palonosetron were also more satisfied than those who received ramosetron (p < 0.05). No difference in adverse events was observed in any of the groups.

Conclusion

To conclude, prophylactic therapy with palonosetron is more effective than prophylactic therapy with ramosetron for the long-term prevention of PONV after cesarean section.

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Compliance with ethical requirements and conflict of interest

This study has been carried out in Medical College and Hospital, Kolkata after obtaining institutional informed consent on 18.7.11, followed by informed consent obtained from all patients included in this study. Suman Chattopadhyay and Sebanti Goswami declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Anaesthesiology, Medical College, Kolkata, 88 College Street, Kolkata, 700073, India

    Suman Chattopadhyay (Associate Professor)

  2. Department of Obstetrics and Gynaecology, Medical College, Kolkata, 88 College Street, Kolkata, 700073, India

    Sebanti Goswami (Associate Professor)

  3. BC-103, Salt Lake, Kolkata, 700064, India

    Suman Chattopadhyay (Associate Professor)

Authors
  1. Suman Chattopadhyay
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  2. Sebanti Goswami
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Corresponding author

Correspondence to Suman Chattopadhyay.

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Chattopadhyay, S., Goswami, S. Palonosetron Versus Ramosetron Prophylaxis for Control of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia. J Obstet Gynecol India 65, 28–33 (2015). https://doi.org/10.1007/s13224-014-0612-6

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  • DOI: https://doi.org/10.1007/s13224-014-0612-6

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