Comparison of ondansetron, granisetron, palonosetron for PONV prophylaxis in neurosurgical procedures

Introduction: Postoperative nausea-vomiting (PONV) is common complication after neurosurgery and 5HT3 antagonists are most commonly used antiemetics in neurosurgery patients. This study was conducted to compare ondansetron, granisetron, palonosetron for PONV prophylaxis in neurosurgical patients. Methods: This prospective, randomized, double blind study was conducted on 75 patients of, either sex, with age 18-60 yrs, ASA grade I - III, undergoing elective neurosurgical procedures under GA. A standard anaesthesia technique was used. At time of dura closure, patients were randomly allocated to one of three groups (n = 25) and received 4 mg i/v ondansetron in group O (n = 25), 1 mg i/v granisetron in group G (n = 25) and 0.075 mg i/v palonosetron in group P (n = 25); 30 minutes before extubation. The need for rescue antiemetic (RAE), episodes of nausea-vomiting, patient satisfaction were observed for 48 hrs postoperatively. Ondansetron 4 mg i/v was used as RAE. At 24 hrs postoperatively, ECG was performed, and any variation from baseline, was noted. Results were compiled and statistical analysis was done using ANOVA, Chi-square, and Kruskal Wallis test. P<0.05 was considered significant. Results: PONV incidence was 88%, 52%, 36% in group O, G and P respectively (p<0.05) in 48 hrs and in initial 4 hrs, it was 88%, 32%, 28% in group O, G and P respectively (p<0.05). Incidence of RAE use in 48 hrs was 72%, 28%, 8% in group O, G and P respectively (p<0.05). Good satisfaction scores were seen in 24%, 84%, 100% in group O, G and P respectively (p<0.05). Conclusion: Palonosetron is an excellent choice for PONV prophylaxis with good safety profile in patients undergoing neurosurgery under GA in comparison to granisetron and ondansetron.