Comparison of the efficacy of acupressure on P6 point, dexamethasone and ondansetron versus palonosetron monotherapy for preventing postoperative nausea and vomiting in laparoscopic surgery

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common occurrence, affecting approximately 70-80% of patients who have undergone surgery, particularly those with multiple risk factors. The aim of our study was to compare the effectiveness of palonosetron as monotherapy versus a combination of ondansetron with dexamethasone and acupressure P6 wristband in preventing PONV and reducing the need for rescue anti-emetics after laparoscopic surgery. Methodology: A randomized controlled trial involving a total of 90 ASA I and II patients with APFEL scores ≥ 2 was conducted. These patients were recruited and randomly assigned to either the monotherapy or the combination therapy group. In the monotherapy group, patients received intravenous (IV) palonosetron 0.075 mg immediately after induction of anesthesia. In the combination therapy group, patients received dexamethasone 8 mg IV and an acupressure P6 wristband immediately after induction. Subsequently, ondansetron 4 mg IV was administered, and the wristband was removed prior to emergence from anesthesia. For both groups, metoclopramide 10 mg IV was available as a rescue anti-emetic if needed. The frequency of PONV and the requirement of rescue anti-emetics were recorded at multiple time points: at 0, 6, 12, 24, and 48 h postoperatively. Results: In the combination therapy group, 13.3% of patients experienced PONV, compared to 33.3% in the palonosetron group. The difference was statistically significant (95% CI 0.107-0.888, P = 0.025). The combination therapy group had a lower incidence of nausea compared to the palonosetron group, particularly at 6 h (2.2% vs 24.4%, 95% CI 0.009-0.571, P = 0.002) and at 12 h (0% vs 11.1%, 95% CI 1.696-2.662, P = 0.021). The incidence of vomiting was significantly lower in the combination therapy group at 6 h (2.2% vs 15.6%, 95% CI 0.015-1.048, P = 0.026). None of the patients in the combination therapy group required rescue anti-emetics, while 17.8% of patients in the palonosetron group requested these post-operatively. The difference was statistically significant (95% CI 1.746-2.814, P = 0.003). Conclusion: The combination therapy with ondansetron, dexamethasone and acupressure P6 wristband significantly reduced the incidence of PONV and the need for rescue anti-emetics when compared with the palonosetron alone. The benefits of the combination therapy were particularly notable at 6 and 12 h postoperatively, as evidenced by the significantly lower incidence of nausea and vomiting during these time periods. Key words: Combination Therapy; Monotherapy; Palonosetron; PONV; Rescue Anti-Emetics Citation: Zhong CW, Mokhtar AM, Nik Mohammad NA, Omar M, Azmi NM, Mazlan MZ. Comparison of the efficacy of acupressure on P6 point, dexamethasone and ondansetron versus palonosetron monotherapy for preventing postoperative nausea and vomiting in laparoscopic surgery. Anaesth. pain intensive care 2023;27(6):625−631; DOI: 10.35975/apic.v27i6.2148 Received: February 02, 2023; Revised: October 15, 2023; Accepted: November 06, 2023