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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 2, June 2015 pp 273-279
Comparison of anti-emetic efficacy of various 5 hydroxy tryptamine-3 receptor antagonists in PONV
Anju Jamwal1, Rajdeep Kaur2, Renu Wakhloo3, Smriti Gulati4
1Assistant Professor, 2PG Student, 3Lecturer, 4Professor, Department of Anaesthesiology, Government Medical College, Jammu, Jammu and Kashmir, INDIA.
Introduction: Post operative nausea and vomiting (PONV) continues to be a significant challenge following many type of anesthetics in modern day anesthesia practice despite the latest advances in anesthesia and the introduction of new class of antiemetic. PONV is defined as nausea, retching and vomiting occurring during first 24-48 hrs after surgery, the three symptoms may occur separately or in combination. Overall incidence of PONV has been reported to between 20% and 30% but can increase up to 80% in patients high risk for PONV. Aims and objectives: To study and compare the antiemetic efficacy of 5 Hydroxy Tryptamine3 Receptor Antagonists (5HTR3RA) i.e. Ondansetron, Ramosetron and palonosetron in patients who are at high risk for PONV undergoing laparosocopic cholecystectomy. Material and method: The present study was conducted in the postgraduate Department of Anesthesiology and Intensive Care GMC Jammu. The study population of 150 patients was randomly selected to compare the antiemetic efficacy of Ondansetron, Ramosetron, Palonosetron in patients undergoing Laparoscopy chloecystectomy under general anesthesia. All the patients enrolled in the study belonged to either ASA class I or II. Patients were divided into 3 groups of 50 each. Group O patients received ondansetron 4 mg, Group R patients received ramosetron 0.3 mg and Group P patients received palonosetron 0.075 mg. our study did not have a control group receiving placebo since we thought that placebo controlled trials may be unethical if active drugs are available because postoperative nausea and vomiting is common and distressing symptom against which effective treatment should be given. It was decide to administer the study drug three minutes before the induction of anaesthesia. Postoperative patients were observed for 48 hrs. Injection Metocloramide 10 mg i/v was used as rescue antiemetic. During first 48 hrs after anaesthesia all episodes of nausea, vomiting, retching, complete response at various time intervals 0-2hrs, 2-6hrs, 6-12hrs, 12-24hrs, 24-48hrs were analyzed statistically. Results: It was observed that all the three groups Ondansetron (Group O), Ramosetron (Group R) and Palonasetron (Group P) were clinically matched with respect to patients demographic data (Age in years’ and weight in kg) and duration of surgery (P>0.05) in our study. It was seen that 83.6% patients in Group O, 89.2% in Group R and 98.4% in Group P had no incidence of Nausea. It was evident from the table that the control over vomiting was significantly better in group P patients as compared to group O and R. In 82.0% Group O and 87.6% in Group R no incidence of Retching was observed. Use of rescue medicine was more in group O and group R as compared to group P. Mean percentage of use of rescue medication in Group O, Group R and Group P was 22.8%, 14.8% and 2.4% respectively. The difference observed in use of rescue medicine in group P was statistically significant as compared to group O and group R. Conclusion: Thus we concluded that a single injection of 0.075 mg of Palonosetron was more effective in preventing PONV and reduced the need of use rescue antiemetic compared to an injection of 4 mg of ondansetron or 0.3 mg of Ramosetron in patients who are at high risk for PONV scheduled for laparosocopic cholecystectomy.