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Comparative study of efficacy of palonosetron, dexamethasone and glycopyrrolate in prevention of postoperative nausea and vomiting in patients undergoing lower abdominal surgeries under spinal anesthesia using bupivacaine with morphine

Introduction: Incidence of post-operative nausea vomiting (PONV) after spinal anesthesia is 21%, which increases to 50% when we add opioid (morphine) adjuvant intrathecally for better analgesia. This study is oriented to search a remedy for this commonest postoperative complication and to compare the efficacy of intravenous Palonosetron, Dexamethasone and Glycopyrrolate given preoperatively in prevention of PONV with intrathecal hyperbaric bupivacaine with morphine, in lower abdominal surgeries. Methods: After Ethical committee clearance, Informed written consent was obtained from 90 ASAI or II patients, between ages 18 and 65 years undergoing surgery under spinal anaesthesia and randomized into three groups to receive either injection Palonosetron 0.075 mg (Group P), injection Dexamethasone 8mg (Group D) or injection Glycopyrrolate 0.2mg (Group G) 15 minutes prior to spinal anesthesia with injection bupivacaine 0.5% hyperbaric 15mg with 100 micrograms preservative free morphine and observed for complete responders, number of episodes of vomiting post operatively over 48 hrs. Pain and sedation assessed by Visual analogue score & Ramsey Sedation Scale respectively. Injection ondansetron 4mg is used as rescue drug. Results: Demographic data and hemodynamic variables were similar in all the groups. The incidence of PONV in Palonosetron and Glycopyrrolate group was13.3 % & in Dexamethasone group was16.7% with p value 0.6 which was similar. Conclusion: The efficacy of premedication with i.v. Dexamethasone or Glycopyrrolate in lower abdominal surgeries in prevention of PONV was comparable with Palonosetron.