Management of postoperative nausea and vomiting: focus on palonosetron

Abstract

Postoperative nausea and vomiting (PONV) remains a significant problem in modern anesthetic practice, with an incidence in high-risk groups of up to 80%. In addition to being unpleasant and distressing for the patient, PONV has the potential to adversely affect patient and surgical outcomes. Advances in PONV prophylaxis over recent years include using non-pharmacological means to reduce baseline risk, a change to less emetogenic anesthetic techniques and the combination of multiple antiemetic drugs. The 5-hydroxytryptamine-3 (5-HT(3)) antagonists have proven a particularly valuable addition to the armamentarium against PONV. Palonosetron is a second-generation 5-HT(3) antagonist that has recently been approved for prophylaxis against PONV. It has unique structural, pharmacological and clinical properties that distinguish it from other agents in its class. This review summarizes current evidence on PONV prophylaxis, reviews the 5-HT(3) antagonists in particular and focuses on the established and future roles of palonosetron.

Figure 1

Structures of palonosetron and other 5-HT₃ antagonists. Reproduced with permission from Rojas C, Grunberg S, Rosti G. 2007. Creating real benefit for patients at risk of nausea and vomiting: palonosetron-from bench to bedside. Clin Adv Hematol Oncol, 5(12 Suppl 19):1–20. Copyright © 2007 Millenium Medical Publishing.

Figure 2

0- to 24-hour PONV: complete response (CR), no nausea and no emesis. *p< 0.017; **p < 0.05. Data derived from Kovac et al 2008 and Candiotti et al 2008. Abbreviations: Palo, palonosetron; PONV, postoperative nausea and vomiting.

Figure 3

24- to 72-hour PONV: complete response (CR) and no emesis. *p< 0.017. Data derived from Kovac et al 2008 and Candiotti et al 2008. Abbreviations: Palo, palonosetron; PONV, postoperative nausea and vomiting.