Palonosetron Versus Ramosetron Prophylaxis for Control of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia

Purpose Postoperative nausea and vomiting (PONV) after spinal anesthesia for cesarean delivery are distressing to both patients and surgeons. This study was designed to evaluate the efficacy and safety of palonosetron and ramosetron (both newer and highly potent 5HT3 receptor antagonists) in nausea and vomiting in cesarean delivery after spinal anesthesia. Methods In this randomized, double-blind study, 109 women received either palonosetron (0.075 mg) or ramosetron (0.3 mg) intravenously immediately after clamping of the fetal umbilical cord. Nausea, vomiting, adverse events, and overall satisfaction were then observed for 48 h after administration of spinal anesthesia. Results A complete response (defined as no postoperative nausea and vomiting) during first 0-2 h postoperative after administration of spinal anesthesia was achieved in 85.5 % of patients with palonosetron and in 83.3 % of patients with ramosetron (p[0.05). However, the corresponding incidence during 2 to 24 h was 70.9 and 53.7 %, respectively (p<0.05), while it was 63.3 and 44.4 % at 24-48 h after anesthesia (p<0.05). Along with a more complete response, the severity of nausea was also lesser with palonosetron during the corresponding study periods (2-24 and 24-48 h, respectively; p < 0.05). Patients who received palonosetron were also more satisfied than those who received ramosetron (p < 0.05). No difference in adverse events was observed in any of the groups. Conclusion To conclude, prophylactic therapy with palonosetron is more effective than prophylactic therapy with ramosetron for the long-term prevention of PONV after cesarean section.