prospective, randomized, double-blind, comparative study of the efficacy of intravenous ondansetron and palonosetron for prevention of postoperative nausea and vomiting

Palonosetron is a second generation 5-Hydroxytryptamine-3 receptor antagonist with longer half life and higher receptor binding affinity than Ondansetron. To assess the efficacy and safety profile of intravenous palonosetron compared to the ondansetron for prevention of post-operative nausea and vomiting [PONV] under general anesthesia. A prospective, randomized, placebo-controlled, double-blind study was conducted in 90 patients aged 20-60 years, undergoing major surgeries. Group I [n=30] received placebo injection; Group II [n=30] received inj. ondansetron 8 mg and Group III [n=30] received inj. palonosetron 0.075 mg IV. In the operating room, the study drugs were given IV in equal volume of 4ml, before inducing the patients. In postoperative period each patient was observed for retching, nausea and/or vomiting at 30 min; and then at 1, 2, 6, 12 and 24 hours. Any side effects intra-operatively and post-operatively were recorded. The number of patients, who remained vomiting free in the first 24 hours after surgery was 56.6%, 80% and 86% in the placebo, Ondansetron and Palonosetron groups respectively. The difference with placebo was highly significant for ondansetron [p < 0.05], and highly significant for palonosetron [p=0.009]. The difference in vomiting between Ondansetron and Palaonosetron was not significant but the incidence of nausea was significantly less common in the Palonosetron group than the Ondansetron group [16.7% vs. 43.4%, p=0.006]. We conclude that the second generation 5-HT3 antagonist, palonosetron is significantly more effective against PONV than ondansetron. It has a particularly more pronounced and prolonged effect on postoperative nausea

randomized, placebo-controlled, doubleblind study of the analgesic efficacy of extraperitoneal wound instillation of bupivacaine and morphine in abdominal surgeries

The use of opioid for blockage of peripheral receptors has been used previously in many surgical settings but with a variable response. However, the use of morphine for extraperitoneal instillation after abdominal surgery has not been studied. We designed this study to evaluate the analgesic efficacy of extraperitoneal wound instillation of bupivacaine and morphine in abdominal surgeries. We also evaluated whether using this combination could lead to improvement of the respiratory functions. After ethical committee clearance, this prospective, randomized, placebo-controlled, double blind study was carried out in sixty patients of age group 18-65 years, undergoing abdominal surgery and specifically requiring midline incision. In the operating room, a standardized technique of general anesthesia was followed. At the end of the surgery a multiport Romovac[registered sign] suction catheter [Romsons Group of Companies India] was placed along the length of the wound between the peritoneal layer and muscle layers and led out through a separate stab wound. The patients were then randomized into three groups: Group C [n-20]: Wound perfused with normal saline; Group B [n-20]: Wound perfused with 0.5% bupivacaine; Group BM [n-20]: Wound perfused with 0.5% bupivacaine along plus morphine [0.05 mg/kg]. 15 ml of solution was given as slow bolus over 2-3 minutes via the catheter. Rescue analgesia was provided with intravenous tramadol [50 mg] if VAS score>30 mm. The VAS score at rest and on coughing was noted at 1, 3, 6, 9, 12, 24 hours. Time to demand the first rescue analgesia was recorded. Vital signs, peak expiratory flow rate and inspiratory flow rate were also recorded at 1, 3, 6, 9, 12 and 24 hour after operation. The demographic profile, type of surgery, duration of surgery were comparable among the three groups [p>0.05]. The peak expiratory flow rate was maximum at any point of time in Group BM as compared to Group C and B [p value <0.05]. But inspiratory flow rate with respect to time was almost same in the three groups [p value >0.05]. The VAS scores [on rest and cough] were significantly lower at all time intervals in Group BM as compared to Group B and C [p value [0.001]. The first rescue analgesia was demanded at 1.25 +/- 0.3 hours in Group C as compared to 3.68 +/- 0.71 hours in Group B and 10.7 +/- 4.1 hours in Group BM [p value 0.001]. We observed from our study that wound perfusion with 0.5% bupivacaine and morphine combination reduces pain and thus the need of rescue analgesia. The combination was also associated with significant improvement in lung functions postoperatively without any additional side effects