Key result
Dexamethasone-palonosetron combination reduces PONV by ~20% at 48 hours versus palonosetron alone.
Why the study?
The efficacy of dexamethasone plus palonosetron for postoperative nausea and vomiting prophylaxis in patients receiving opioid-based analgesia was not firmly established.
Does the combination of palonosetron and dexamethasone reduce postoperative nausea and vomiting in patients receiving opioid-based analgesia after upper extremity surgery?
RCT (n=192)
Double-blind
Computer-generated random-number codes
No
Does the combination of palonosetron and dexamethasone reduce postoperative nausea and vomiting in patients receiving opioid-based analgesia after upper extremity surgery?
Absolute Event Rate: 61.5% vs 77.1%
p-value: p=0.019
The addition of dexamethasone to palonosetron significantly reduces the incidence of postoperative nausea and vomiting and postoperative pain in patients receiving opioid-based analgesia after upper extremity surgery.
Supports adding dexamethasone to palonosetron for PONV prevention after upper extremity surgery; extends combination antiemetic evidence to opioid analgesia.
Background: The efficacy of dexamethasone plus palonosetron for postoperative nausea and vomiting (PONV) prophylaxis is not firmly established.This randomized, double-blind, controlled study evaluated whether the combination was superior to palonosetron alone in preventing PONV in patients receiving intravenous patient-controlled analgesia (IV-PCA) after upper extremity surgery.Methods: A total of 202 patients undergoing upper extremity surgery were randomly assigned to group P (palonosetron alone) or group PD (palonosetron plus dexamethasone).Group P patients received palonosetron 0.075 mg and normal saline 1.6 mL; group PD patients received palonosetron 0.075 mg and dexamethasone 8 mg.In both groups, palonosetron was added to the IV-PCA opioid infusion, which was continued for 48 h postoperatively.Incidence and severity of nausea, incidence of vomiting, rescue antiemetic requirements, pain intensity, and rescue analgesic requirements were evaluated for 72 h postoperatively.Quality of recovery was assessed using the quality of recovery-15 (QoR-15) questionnaire.Results: The incidence of PONV was significantly lower in group PD than in group P at 0-48 h postoperatively (61.5% vs 77.1%; p = 0.019).Severity of nausea at 0-6 h postoperatively was significantly less in group PD compared with group P (none/mild/moderate/severe: 49/22/15/10 vs. 36/16/25/19, p = 0.008).The incidence of vomiting and rescue antiemetic requirements were similar between groups.Pain intensity was significantly less in group PD than in group P at 0-48 h and 48-72 h postoperatively.Global QoR-15 was similar 24 h postoperatively between groups.Conclusions: Dexamethasone-palonosetron combination therapy reduced PONV incidence and postoperative pain in patients receiving opioid-based analgesia after upper extremity surgery.
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Cho et al. (2018) conducted an RCT in Postoperative nausea and vomiting (PONV) (n=192). Palonosetron plus dexamethasone vs. Palonosetron 0.075 mg alone was evaluated on Overall incidence of PONV for the first 48 hours after surgery (p=0.019). Dexamethasone-palonosetron combination therapy significantly reduced the incidence of postoperative nausea and vomiting at 0-48 hours compared to palonosetron alone (61.5% vs 77.1%, p=0.019).
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