Department of Anaesthesiology and Pain Medicine, Seoul St Mary' s Hospital, Catholic University College of Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2012 Mar;108(3):417-22. doi: 10.1093/bja/aer423. Epub 2012 Jan 25.
Palonosetron is a new potent 5-hydroxytryptamine 3 antagonist. Although this drug is thought to be more effective in patients receiving opioid-based patient-controlled analgesia (PCA), clinical data are lacking. This study compared the effects of i.v. ondansetron and palonosetron administered at the end of surgery in preventing postoperative nausea and vomiting (PONV) in high-risk patients receiving i.v. PCA after thyroidectomy.
A total of 100 female non-smoking subjects were randomly assigned into a palonosetron group or an ondansetron group. Ondansetron was given as an 8 mg bolus and 16 mg was added to the i.v. PCA mixture. In the palonosetron group, 0.075 mg was injected as a bolus only. Fentanyl-based PCA was provided for 24 h after operation. The incidence of nausea and vomiting, severity of nausea, requirement for rescue anti-emetics, and adverse effects were evaluated during 0-2 and 2-24 h.
The incidence of PONV during the 24 h postoperative period was lower in the palonosetron group than in the ondansetron group (42% vs 62%, P=0.045). No differences were observed between the groups during the first 2 h. However, the incidence of nausea and vomiting and nausea severity were significantly lower in the palonosetron group than in the ondansetron group during 2-24 h. The only difference in the use of rescue anti-emetics was at 2-24 h (10% with palonosetron compared with 28% with ondansetron, P=0.02).
Palonosetron is more effective than ondansetron for high-risk patients receiving fentanyl-based PCA after thyroidectomy, especially 2-24 h after surgery.
帕洛诺司琼是一种新型强效 5-羟色胺 3 拮抗剂。虽然该药被认为在接受基于阿片类药物的患者自控镇痛（PCA）的患者中更有效，但临床数据仍缺乏。本研究比较了术毕静脉给予昂丹司琼和帕洛诺司琼对甲状腺切除术后接受静脉 PCA 的高危患者预防术后恶心呕吐（PONV）的效果。
将 100 例非吸烟女性患者随机分为帕洛诺司琼组或昂丹司琼组。昂丹司琼组给予 8mg 负荷剂量，静脉 PCA 混合液中追加 16mg；帕洛诺司琼组仅给予 0.075mg 负荷剂量。术后 24h 内给予芬太尼 PCA。评估术后 0-2h 和 2-24h 时恶心呕吐的发生率、恶心的严重程度、需要解救性止吐药的情况和不良反应。
在术后 24h 期间，帕洛诺司琼组 PONV 的发生率低于昂丹司琼组（42%比 62%，P=0.045）。两组在前 2h 时无差异。但在 2-24h 期间，帕洛诺司琼组恶心呕吐和恶心严重程度的发生率均低于昂丹司琼组。仅在 2-24h 时解救性止吐药的使用有差异（帕洛诺司琼组 10%比昂丹司琼组 28%，P=0.02）。
帕洛诺司琼对甲状腺切除术后接受芬太尼 PCA 的高危患者比昂丹司琼更有效，尤其在术后 2-24h 时。
