Background: Hysterectomy is a widely performed surgery and neuraxial anesthesia with intrathecal morphine\nprovides superior quality of recovery. Postoperative nausea and vomiting (PONV) is a frequent problem with\nintrathecal morphine use. Although palonosetron is effective for prevention of PONV after general anesthesia, its\nefficacy after neuraxial anesthesia has not been established. This study was conducted to compare the use of\npalonosetron with ondansetron for PONV prophylaxis in patients at a high risk of PONV during total abdominal\nhysterectomy (TAH) under spinal anesthesia with intrathecal morphine.\nMethods: This prospective, randomized double-blind study conducted at São Rafael Hospital involved 140\nAmerican Society of Anesthesiologists physical status I or II women who underwent TAH under spinal anesthesia\nwith intrathecal morphine and who had at least 3 risk factors for PONV based on Apfelâ??s simplified score. The\npatients were randomized into two groups: one received palonosetron whereas the other received ondansetron. All\npatients received spinal anesthesia with intrathecal morphine, as well as dexamethasone plus palonosetron or\nondansetron for PONV prophylaxis. The overall incidence of PONV, incidence of early- and late-onset nausea and\nvomiting, severity of nausea, and use of rescue antiemetics were recorded.\nResults: The overall incidence of PONV was 42.9% in the palonosetron group and 52.9% in the ondansetron group\n(p > 0.05). No significant differences existed in the incidence of early- and late-onset nausea or early-onset vomiting\nbetween the two groups. The incidence of late-onset vomiting was significantly lower in the palonosetron group.\nConclusions: Palonosetron exhibited efficacy similar to that of ondansetron for reducing the overall incidence of\nPONV after TAH under spinal anesthesia with intrathecal morphine; however, palonosetron reduced the incidence\nof late-onset vomiting significantly better than ondansetron.
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