Background
Postoperative nausea and vomiting (PONV) is a common postoperative complication. Selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have been reported to be effective in preventing PONV. The objective of this study is to evaluate the efficacy of palonosetron and ramosetron for the prevention of PONV in high risk patients undergoing gynecologic laparoscopic surgery.
Methods
In this randomized, double-blind, placebo-controlled study, a total of 87 female patients who were undergoing elective gynecologic laparoscopic surgery under general anesthesia were included. Patients were randomly divided into the following three groups: palonosetron group (0.075 mg i.v.; n=29), ramosetron group (0.3 mg i.v.; n=29), and control group (0.9 % normal saline i.v.; n=29). The occurrence of nausea and vomiting, and the severity of nausea were evaluated using visual analogue scale, and administration of rescue anti-emetics was monitored during 48 hours after the end of surgery.
Results
The incidence of nausea was significantly lower in the palonosetron and ramosetron groups compared with the control group (34.5% vs 31.0% vs 65.5%, p=0.014) during 2 hours postoperatively, but not during 48 hours postoperatively.  There were no significant differences in the incidence of vomiting and overall PONV, and the administration of rescue anti-emetics among the 3 groups.
Conclusions
Prophylaxis with ramosetron or palonosetron effectively decreases the incidence of PONV during the early postoperative period.

Effect of total intravenous anesthesia and prophylactic 5-HT3 receptor antagonist on postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective, randomized controlled study