Comparative Efficacy of Palonosetron–Dexamethasone Versus Granisetron–Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Review With Focus on Otologic Surgeries

Postoperative nausea and vomiting (PONV) remain one of the most distressing and consequential complications in perioperative care, with a particularly high incidence in otologic surgeries, where vomiting can jeopardize graft stability and hearing outcomes. This review provides a focused, evidence-based evaluation of the comparative efficacy of palonosetron-dexamethasone and granisetron-dexamethasone combinations in preventing PONV, integrating pharmacologic insights with procedure-specific clinical implications. Drawing upon studies published between 2015 and 2025, it highlights the superior and sustained efficacy of palonosetron, a second-generation serotonin (5-hydroxytryptamine type 3; 5-HT₃) receptor antagonist, due to its longer half-life, allosteric receptor binding, and enhanced pharmacodynamic stability. The synergistic benefit of combining a 5-HT₃ receptor antagonist with dexamethasone, a corticosteroid with anti-inflammatory and central inhibitory properties, is emphasized, demonstrating improved control of both early and delayed PONV with minimal adverse effects. Moreover, the review contextualizes these findings within the unique challenges of otologic procedures and discusses their safety, cost-effectiveness, and clinical applicability. By bridging pharmacologic evidence with surgical realities, this review underscores the need for procedure-specific, long-acting antiemetic strategies and advocates for multicentric, cost-conscious research to refine prophylactic protocols. Ultimately, it offers a novel synthesis that advances PONV management in otologic surgery through the integration of clinical efficacy, patient safety, and economic prudence. The evidence supports palonosetron-dexamethasone as the more effective and sustained prophylactic regimen compared with granisetron-dexamethasone, particularly for delayed PONV (6-48 h) in otologic surgeries. Palonosetron-based dual therapy should be preferred in high-risk middle ear procedures where postoperative vomiting may compromise graft integrity, while granisetron-dexamethasone remains a reasonable lower-cost option for shorter or lower-risk cases.