Effects of pretreatment with intravenous palonosetron for propofol-remifentanil-based anesthesia in breast and thyroid cancer surgery: a double-blind, randomized, controlled study

Abstract

Background: We postulated that palonosetron, a novel antiemetic agent, might have the effect of alleviating injection pain from propofol and rocuronium. A double-blind, controlled study was undertaken to evaluate the effect of palonosetron on injection pain during total intravenous anesthesia and postoperative nausea and vomiting (PONV) using propofol-remifentanil in breast and thyroid cancer surgery.

Methods: Sixty patients were randomly allocated to one of two groups. Before injection of propofol and rocuronium, patients in group S (n = 30) received 4 ml of saline and patients in group P (n = 30) received 75 µg (1.5 ml) of palonosetron mixed with 2.5 ml of saline (n = 30). Patients were evaluated by a blinded anesthesiologist with regard to the scoring of injection pain of propofol, withdrawal response by rocuronium, PONV, shivering, postoperative pain, recall of pain, and overall satisfaction.

Results: The differences between groups in the incidence of injection pain due to propofol and rocuronium were insignificant. However, in group P, the severity of propofol-induced injection pain (3% vs. 33%, P = 0.003) and postoperative pain (P = 0.038) was significantly lower during the first 12 h after surgery. No differences were observed between the groups with respect to PONV, shivering, recall of pain, and overall satisfaction.

Conclusions: We concluded that pretreatment of palonosetron was effective to reduce the severity of propofol-induced injection pain and early postoperative pain, although it did not reduce the incidence of injection pain from propofol and rocuronium.

Keywords: Pain; Palonosetron; Postoperative nausea and vomiting; Propofol.

Fig. 1

Distribution of injection pain grades for propofol in the two groups. Data are presented as the number of patients. Group S: patients who received normal saline, Group P: patients who received palonosetron. Grade 0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain. ^*P = 0.003, group P versus group S in grade 3.

Fig. 2

Distribution of withdrawal movement grades during rocuronium injection. Data are presented as the number of patients. Group S: patients who received normal saline, Group P: patients who received palonosetron. Withdrawal grade 0 = no response, 1 = movement at the wrist only, 2 = movement involving the arm only, 3 = generalized movement in more than one extremity. There are no significant differences between the groups.