“A Comparative Study of Intravenous Ondansetron and Palonosetron for Prevention of Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy”

Background: Postoperative nausea and vomiting (PONV) remain among the most common and distressing complications following anesthesia and surgery, particularly after laparoscopic cholecystectomy. The incidence of PONV after laparoscopic procedures ranges from 40% to 80% in high-risk patients. PONV can lead to patient discomfort, delayed recovery, prolonged hospital stay, increased healthcare costs, and reduced patient satisfaction. Among the various pharmacological agents used for prophylaxis, 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron and palonosetron have demonstrated significant efficacy. Palonosetron, a second-generation 5-HT3 receptor antagonist, possesses a longer half-life and higher receptor-binding affinity compared to ondansetron, potentially providing superior protection against PONV.Aim: To compare the efficacy and safety of intravenous ondansetron and intravenous palonosetron in preventing postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.Objectives: The  evaluate the incidence of postoperative nausea in patients receiving ondansetron and palonosetron.To compare the incidence of postoperative vomiting between the two study groups.To assess the requirement for rescue antiemetic therapy.To compare the safety profile and adverse effects of both drugs.To determine overall patient satisfaction with antiemetic prophylaxis.Methodology: A prospective, randomized, comparative study was conducted among 100 patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly divided into two groups of 50 each. Group O received intravenous ondansetron 4 mg, while Group P received intravenous palonosetron 0.075 mg prior to induction of anesthesia. Patients were monitored for 24 hours postoperatively for the occurrence of nausea, vomiting, requirement of rescue antiemetics, adverse drug reactions, and overall patient satisfaction. Data were analyzed using descriptive and inferential statistical methods, including Chi-square test and Student’s t-test. A p-value of <0.05 was considered statistically significant.Results: The incidence of PONV within 24 hours was significantly lower in the palonosetron group compared to the ondansetron group. Postoperative nausea occurred in 10% of patients in Group P compared with 24% in Group O. Vomiting was observed in 6% of patients receiving palonosetron and 18% of patients receiving ondansetron. The requirement for rescue antiemetic medication was lower in Group P. Both drugs were well tolerated, with minimal adverse effects. Patient satisfaction scores were significantly higher among patients receiving palonosetron.Conclusion: Intravenous palonosetron demonstrated superior efficacy compared with intravenous ondansetron in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy. Its prolonged duration of action, reduced incidence of PONV, lower requirement for rescue antiemetics, and favorable safety profile make palonosetron an effective choice for prophylactic management of PONV in laparoscopic surgical patients. The findings support current evidence and international guidelines recommending the use of long-acting 5-HT3 receptor antagonists for patients at moderate to high risk of postoperative nausea and vomiting.