Palonosetron and Dexamethasone for Postoperative Nausea and Vomiting Prevention, Suggests Study

Finding a universally effective treatment for the high rates of postoperative nausea and vomiting (PONV) in laparoscopic surgeries remains a clinical challenge. To address this, researchers Anish Kumar M and Kalpana S Shah compared the efficacy of palonosetron alone versus a palonosetron-dexamethasone combination.

Therefore, a randomized clinical study of 138 adults undergoing elective laparoscopic surgery compared the use of intravenous palonosetron alone to a palonosetron-dexamethasone combination. The study primarily evaluated their effects on the incidence of postoperative nausea and vomiting (PONV) alongside the need for rescue antiemetics.

Key Clinical Findings of the Study Includes:

• Overall Incidence: Analysis demonstrated that throughout the full 48-hour follow-up window, significantly fewer patients in the combination cohort experienced PONV compared to the monotherapy cohort (10.1% versus 27.5%).

• Early Postoperative Period: Researchers found an exceptionally marked reduction in PONV occurrence during the immediate 0–4 hour recovery phase for the dual therapy group at 4.3%, heavily contrasting the 21.7% observed in the single-drug group.

• Rescue Antiemetics: Investigators noted that the requirement for supplementary rescue metoclopramide was substantially lower in the combined treatment group (4.3%) than in the single-agent group (10.1%), although this numerical difference did not achieve statistical significance.

• Gender Differences: Observation indicated that female patients receiving solely palonosetron exhibited a remarkably higher PONV incidence compared to females on the combination regimen, whereas corresponding variations among male participants were statistically negligible.

The results suggest that administering a combined therapy of 75 µg palonosetron and 8 mg dexamethasone is significantly superior to palonosetron monotherapy, effectively lowering the overall PONV incidence to a mere 10.1% while concurrently decreasing the frequency at which patients require rescue antiemetics.

Thus, the study concludes that incorporating this dual antiemetic medication strategy into routine practice may gently assist healthcare professionals in minimizing distressing postoperative symptoms, ultimately supporting smoother patient recoveries with minimal adverse effects during laparoscopic interventions.

The current findings are inherently constrained by utilizing a relatively narrow sample of lower-risk, elective surgical patients aged 18 to 60, suggesting that future clinical investigations encompassing broader demographic profiles and lengthier follow-up timelines might be beneficial to further confirm the sustained applicability of this multimodal prophylaxis.

Reference

Anish KM, Shah KS. Comparison between Palonosetron and Palonosetron with Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Laparoscopic Surgeries: A Prospective Randomized Comparative Open Clinical Study. Res and Innov Anesth 2025;10(2):33–38.