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Abstract Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma, for which cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab(R–CHOP) is one of the standard regimens. Given that R–CHOP is highly emetogenic, chemotherapy-induced nausea and vomiting (CINV) prevention is clinically important. However, there is a paucity of studies focusing on these patients. This study aimed to ascertain the effectiveness of an oral fixed-dose combination of netupitant and palonosetron (NEPA) in preventing CINV in patients with DLBCL undergoing first-line R-CHOP chemotherapy. Seventy patients were enrolled in this single-center prospective non-comparative study conducted between November 2020 and May 2023 in South Korea. NEPA was administered 1 h prior to chemotherapy initiation on day 1. The primary endpoint of the study was the complete response rate (no emesis, and no rescue medication) during the acute, delayed, and overall phases, which were assessed over a period of 120 h post-chemotherapy. The complete response rates for NEPA were 90.0% [95% CI 80.5, 95.9] for the acute phase, 85.7% [95% CI 75.3, 92.9] for the delayed phase, and 84.3% [95% CI 73.6, 91.9] for the overall phase, with no-emesis rates (acute: 97.1% [95% CI 97.1, 99.7], delayed: 95.7% [95% CI 88.0, 99.1], overall: 92.9% [95% CI 84.1, 97.6]). NEPA was well tolerated with no severe treatment-emergent adverse events. NEPA exhibited substantial efficacy in mitigating CINV in DLBCL patients undergoing R–CHOP chemotherapy, demonstrating high CR and no-emesis rates, and favorable safety profiles.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma, for which cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab(R–CHOP) is one of the standard regimens. Given that R–CHOP is highly emetogenic, chemotherapy-induced nausea and vomiting (CINV) prevention is clinically important. However, there is a paucity of studies focusing on these patients. This study aimed to ascertain the effectiveness of an oral fixed-dose combination of netupitant and palonosetron (NEPA) in preventing CINV in patients with DLBCL undergoing first-line R-CHOP chemotherapy. Seventy patients were enrolled in this single-center prospective non-comparative study conducted between November 2020 and May 2023 in South Korea. NEPA was administered 1 h prior to chemotherapy initiation on day 1. The primary endpoint of the study was the complete response rate (no emesis, and no rescue medication) during the acute, delayed, and overall phases, which were assessed over a period of 120 h post-chemotherapy. The complete response rates for NEPA were 90.0% [95% CI 80.5, 95.9] for the acute phase, 85.7% [95% CI 75.3, 92.9] for the delayed phase, and 84.3% [95% CI 73.6, 91.9] for the overall phase, with no-emesis rates (acute: 97.1% [95% CI 97.1, 99.7], delayed: 95.7% [95% CI 88.0, 99.1], overall: 92.9% [95% CI 84.1, 97.6]). NEPA was well tolerated with no severe treatment-emergent adverse events. NEPA exhibited substantial efficacy in mitigating CINV in DLBCL patients undergoing R–CHOP chemotherapy, demonstrating high CR and no-emesis rates, and favorable safety profiles. [ABSTRACT FROM AUTHOR]

Background: Incidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70-80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing ENT surgeries conducted under general anaesthesia. Aim: The objective of the present studyis to compare the intravenous Palonosetron with intravenous Ondansetron for prevention of nausea and vomiting during postoperative period in patients undergoing ENT Surgeries underGeneral Anaesthesia. Material and Methods: This was a randomized double blindclinical study conducted on 60 ASA Grade I&II patients scheduled for ENT Surgeries under General Anaesthesia and were randomlydivided into two groups, Group I and Group II, each consisting of30 patients. Group I received 4 mg of Ondansetron I.V and GroupII received 1.5 mcg/kg of Palonosetron I.V, 30 minutes before theinduction of anaesthesia. The incidences of PONV were recorded within the first 72 hours after surgery at intervals of: 0-12 hours, 12-24 hours and 24-72 hours. Episodes of PONV were identifiedby spontaneous complaints by the patients, by direct questioningand by Nausea Scale (Visual Analogue Scale) 0 - 10. Results: There were no differences in the demographic databetween the two study groups. The incidence of PONV was significantly less in the palonosetrongroup (5.55%) as compared to the ondansetron group (43.33%), with a lesser need for rescue antiemetic in the palonosetron group (10% vs. 53%). Both the study groups did not have significantadverse effects reflecting that both the drugs were well-tolerated. Conclusion: In conclusion, we have found that Palonosetron at adose of 1.5mcg/Kg IV is safe and well-tolerated and proved more effective than Ondansetron 4 mg IV in the prevention of PONV. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the efficacy and safety of netupitant/palonosetron (NEPA) for the prevention of chemotherapy-induced nausea and vomiting (CINV) for hematopoietic cell transplantation (HCT) patients receiving BEAM therapy. Study Design: This phase II, prospective, intention-to-treat, single-center, single-arm study involved 43 adult patients who received NEPA and dexamethasone for the prevention of CINV due to BEAM conditioning chemotherapy. An interim analysis, performed after 13 patients, determined utility versus futility, and supported continuation to full enrollment. Descriptive statistics were used to report complete response (CR), complete protection, incidence of emesis, and administration of rescue agents. A Kaplan–Meier curve depicted time to first emesis and first rescue medication. Patients self-reported levels of daily nausea descriptively via a CINV Questionnaire. Results: By study end, 13 of 43 patients achieved a CR with an average of 10.6 emesis-free days (SD 0.95) over the 11-day observation period, with no emetic events in any patient during the acute/chemotherapy phase. Nausea was well-controlled throughout the acute therapy phase (Day 1–6) and increased during the delayed phase (Day 7–11) with a peak mean level of 2.79/10 at Day 10. Aside from lower grade (≤2), headaches, constipation, and diarrhea were the most widely reported adverse effects. Conclusion : The combination of NEPA and dexamethasone is safe and effective for the prevention of CINV in patients receiving BEAM conditioning therapy prior to HCT. The regimen demonstrated greater effectiveness in the acute phase versus the delayed phase, with low levels of nausea throughout the study period and complete emesis prevention during chemotherapy. [ABSTRACT FROM AUTHOR]

Summary: Dexamethasone is one of the key antiemetic agents and is widely used even now. However, dexamethasone has been associated with several adverse reactions even after short-term administration. Therefore, developing a steroid-free antiemetic regimen is an important issue to consider. Thus, the purpose of this study was to investigate the efficacy and safety of palonosetron, aprepitant, and olanzapine in a multi-institutional phase II study. Chemotherapy-naive patients scheduled to receive cisplatin were enrolled and evaluated for the occurrence of chemotherapy-induced nausea and vomiting during 120 h after chemotherapy. The primary endpoint of the study was total control (TC) in the overall phase. The key secondary endpoint was complete response (CR), which was assessed in the acute, delayed, and overall phase, respectively. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events. Eighty-five patients were enrolled from 8 centers in Japan, of which 83 were evaluable for analyses. The percentage of patients who achieved TC during the overall phase was 31.3%. CR was achieved in 61.4%, 84.3%, and 65.1% of patients during the overall, acute, and delayed phases, respectively. The most frequently reported adverse event was anorexia. The primary endpoint was below the threshold and we could not find benefit in the dexamethasone-free regimen, but CR during the overall phase was similar to that of the conventional three-drug regimen. This antiemetic regimen without dexamethasone might be an option for patients for whom corticosteroids should not be an active application. [ABSTRACT FROM AUTHOR]

BACKGROUND Ondansetron is currently one of the commonly used drug for prevention of postoperative nausea and vomiting in adults. New drugs such as Palonosetron have emerged as alternative for postoperative nausea and vomiting in adults. Both have been tried for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic gynaecological surgeries. We, therefore conducted a prospective, randomized, double blind comparative study to compare the efficacy of injection ondansetron 4 mg with palonosetron 75µg to prevent postoperative nausea and vomiting in female patients undergoing general anaesthesia for elective laparoscopic non gynaecological surgeries. MATERIALS AND METHODS This was a prospective, randomized, double blinded, comparative study. All thepatients were well informed about study & each one of them gave written in formed & valid consent to participate in the study. Total number of patients in the study was 100, with 50 patients in each of the two groups. Grouping done as follows Group I Injection Ondansetron 4 mg Group II Injection Palonosetron 75 mcg RESULTS The demographic data were comparable in both the groups. The incidence of nausea in ondansetron group at 0 hrs, 1hrs, 2hrs, 3hrs, 12hrs, 24hrs, 48hrs are 12%, 12%, 08%, 04%, 0%, and 0% and in palonosetron group is 2%, 12%, 0%, 2%, 2%, 0% and 0% respectively. The incidence palonosetron and ondansetron groups though look clinically significant did not reach statistical significance. The incidence of vomiting in ondansetron was 0%, 6%, 10%, 10%, 2%, 0% and 0% and in palonosetron was 0%, 8%, 8%, 2%, 0%, 0% and 0% at 0 hrs, 1hrs, 2hrs, 3 hrs, 12hrs, 24hrs and 48hrs respectively. The incidence of requirement of rescue antiemetic in ondansetron group at 0hrs, 1hrs, 2hrs, 3hrs, 12hrs, 24hrs and 48 hrs are 0(0%),5 (10%),5(10%), 6(12%), 1(2%), 0(0%),0(0%) and in palonosetron group 0(0%),4(08%),4(08%),02(04%), 0(0%), 0(0%), 0(0%) respectively. CONCLUSION We found no statistical significance in terms of nausea, vomiting and the administration of rescue antiemetic between the two groups in the 48hour observation period. As per the study, both drugs are equally effective in the 48 hour observation period. [ABSTRACT FROM AUTHOR]

Purpose: Chemotherapy-induced nausea and vomiting (CINV) are common adverse events in patients undergoing emetogenic chemotherapy. Palonosetron, a second-generation 5-hydroxytryptamine-3 receptor antagonist (5-HT3 RA), has demonstrated non-inferiority to first-generation 5-HT3 RAs for CINV in pediatric patients. Although palonosetron has a long half-life and prolonged antiemetic action, its efficacy against delayed CINV in pediatric patients is not well understood. Therefore, this meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of palonosetron for delayed CINV in pediatric patients. Methods: A literature search of MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science databases was performed. A meta-analysis was performed using forest plots, and risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. A funnel plot was constructed to explore publication bias. Results: The literature search retrieved 842 records, of which 23 full-text articles were assessed, including six RCTs. Meta-analysis of four RCTs that reported on the complete response (CR: defined as no emesis and no rescue medication) rate for delayed CINV revealed that palonosetron was statistically superior to first-generation 5-HT3 RAs (RR = 1.21 [95% CI 1.09–1.35]; p < 0.01). Although the number of studies included was small, no publication bias was observed in the funnel plots. In addition, the CR rate for overall and acute CINV was also significantly higher for palonosetron (RR = 1.25 [95% CI 1.01–1.54]; p = 0.04 and RR = 1.06 [95% CI 1.01–1.12]; p = 0.03, respectively). Conclusion: Palonosetron is effective in the prophylaxis of delayed CINV in pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative nausea and vomiting is still a common complication. Serotonin receptor antagonists are commonly used in clinical practice for antiemetic prophylaxis. Interindividual variations in drug response, including single nucleotide polymorphisms, are related to pharmacokinetic and pharmacodynamic changes in these drugs and may lead to a poor therapeutic response. This study aimed to evaluate the influence of CYP2D6 isoenzyme and ABCB1 gene polymorphisms on the frequency of postoperative nausea and vomiting with the use of ondansetron or palonosetron. Methods: A randomized, double-blind clinical trial including 82 women aged 60 years or over undergoing laparoscopic cholecystectomy was conducted. Patients were randomized to receive either ondansetron or palonosetron for postoperative nausea and vomiting prophylaxis. DNA was extracted from saliva. Genetic polymorphisms were analyzed by real-time polymerase chain reaction. The following polymorphisms were analyzed: rs3892097 C/T, rs1128503 A/G, rs16947 A/G, rs1065852 A/G, rs1045642 A/G, rs2032582 C/A, and rs20325821 C/A. Results: Overall, vomiting, and severe nausea occurred in 22.5% and 57.5% of patients, respectively. In the palonosetron group, patients with the GG genotype (rs16947 A/G) experienced more severe nausea (p = 0.043). In the ondansetron group, patients with the AA genotype (rs16947 A/G) presented mild nausea (p = 0.034), and those with the AA genotype (rs1065852 A/G) experienced more vomiting (p = 0.034). Conclusion: A low antiemetic response was observed with ondansetron in the presence of the AA genotype (rs16947 A/G) and the AA genotype (rs1065852 A/G), and a low therapeutic response was found with palonosetron in the presence of the GG genotype (rs16947 A/G) in laparoscopic cholecystectomy. Register: ClinicalTrials.gov.

Butorphanol has been used to reduce the incidence and severity of neuraxial morphine-induced pruritus. Palonosetron is a commonly used antiemetic for the prevention of postoperative nausea and vomiting. The aim of our study was to compare the effective dose in 50% of subjects (ED50) of intravenous butorphanol infusion with or without a single intravenous bolus of palonosetron for preventing pruritus induced by epidural administration of morphine. A total of 120 parturients were randomly assigned to receive an intravenous bolus injection of palonosetron plus continuous infusion of butorphanol (Group P + B) or an intravenous bolus of saline plus continuous infusion of butorphanol (Group B) after epidural administration of morphine. The antipruritic effect was graded as satisfactory (numerical rating scale (NRS) of pruritus ≤3) or unsatisfactory (NRS >3) within 48 h after morphine treatment. The first patient in each group received butorphanol infusion at a rate of 4 µg/kg/h. The infusion dose for each subsequent patient in the corresponding group was increased by 0.2 µg/kg/h after an unsatisfactory response or decreased by 0.2 µg/kg/h after a satisfactory response. The ED50 was calculated for each group and compared using up-down sequential analysis. The ED50 (mean [95% confidence interval (CI)]) of the dose of intravenous butorphanol infusion for preventing moderate to severe pruritus was lower in Group P + B (3.29 µg/kg/min [3.25–3.34 µg/kg/min]) than in Group B (3.57 µg/kg/min [3.47–3.67 µg/kg/min]) (p < 0.05). Under the conditions of the present study, a prophylactic use of 0.25 mg palonosetron reduced the ED50 of prophylactic infusion of butorphanol by approximately 8% to achieve a satisfactory antipruritic effect after epidural morphine for post-caesarean analgesia. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) is a common occurrence, affecting approximately 70-80% of patients who have undergone surgery, particularly those with multiple risk factors. The aim of our study was to compare the effectiveness of palonosetron as monotherapy versus a combination of ondansetron with dexamethasone and acupressure P6 wristband in preventing PONV and reducing the need for rescue anti-emetics after laparoscopic surgery. Methodology: A randomized controlled trial involving a total of 90 ASA I and II patients with APFEL scores ≥ 2 was conducted. These patients were recruited and randomly assigned to either the monotherapy or the combination therapy group. In the monotherapy group, patients received intravenous (IV) palonosetron 0.075 mg immediately after induction of anesthesia. In the combination therapy group, patients received dexamethasone 8 mg IV and an acupressure P6 wristband immediately after induction. Subsequently, ondansetron 4 mg IV was administered, and the wristband was removed prior to emergence from anesthesia. For both groups, metoclopramide 10 mg IV was available as a rescue anti-emetic if needed. The frequency of PONV and the requirement of rescue anti-emetics were recorded at multiple time points: at 0, 6, 12, 24, and 48 h postoperatively. Results: In the combination therapy group, 13.3% of patients experienced PONV, compared to 33.3% in the palonosetron group. The difference was statistically significant (95% CI 0.107-0.888, P = 0.025). The combination therapy group had a lower incidence of nausea compared to the palonosetron group, particularly at 6 h (2.2% vs 24.4%, 95% CI 0.009-0.571, P = 0.002) and at 12 h (0% vs 11.1%, 95% CI 1.696-2.662, P = 0.021). The incidence of vomiting was significantly lower in the combination therapy group at 6 h (2.2% vs 15.6%, 95% CI 0.015-1.048, P = 0.026). None of the patients in the combination therapy group required rescue anti-emetics, while 17.8% of patients in the palonosetron group requested these post-operatively. The difference was statistically significant (95% CI 1.746-2.814, P = 0.003). Conclusion: The combination therapy with ondansetron, dexamethasone and acupressure P6 wristband significantly reduced the incidence of PONV and the need for rescue anti-emetics when compared with the palonosetron alone. The benefits of the combination therapy were particularly notable at 6 and 12 h postoperatively, as evidenced by the significantly lower incidence of nausea and vomiting during these time periods. [ABSTRACT FROM AUTHOR]

Background. Propofol is widely used for induction and maintenance of anaesthesia and possesses many characteristics of an ideal intravenous anaesthetic agent. It is known to cause severe, sharp, stinging, or burning pain on injection, which is considered unacceptable as it can cause agitation and interfere with the smooth induction of anaesthesia. In this study, we compare palonosetron and normal saline for decreasing pain on injection of propofol during intravenous induction of anaesthesia. Material and methods. One hundred adult patients belonging to ASA physical status I or II, scheduled for elective surgeries under general anaesthesia, were selected and randomly allocated to two groups. Group P received an injection of palonosetron, and Group S received an injection of regular saline as a pretreatment before the propofol injection. Patients were assessed for pain on propofol injection. Haemodynamic parameters and electrocardiography were recorded at the following points of time: prior to induction, after pretreatment, induction, and half-hourly during the surgery. Results. Comparing pain during propofol injection, 32% of the palonosetron group and 4% of the regular saline group did not experience pain; 54% of the palonosetron group and 20% of the regular saline group suffered mild pain; 12% of the palonosetron group and 48% of the regular saline group developed moderate pain; 2% of the palonosetron group and 28% of the regular saline group experienced severe pain. Conclusions. Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of propofol-induced pain on injection, with the added advantage of decreased postoperative nausea and vomiting without significant haemodynamic changes. [ABSTRACT FROM AUTHOR]

Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18...60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30.ßseconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72.ßhours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6.ßhours (12.5% vs. 32.1%, p.ß=.ß0.013) and 72.ßhours (1.8% vs. 33.9%, p.ß

Background: Chemotherapy-induced nausea and vomiting (CINV) is a common and significant problem in children receiving chemotherapy. While 5-HT3 blockers are commonly used antiemetics, there is no consensus about choice among them. This study was planned to look for clinician preference for 5-HT3 blocker agent, clinical efficacy, and need for rescue medicines. Material and methods: The prospective, observational study was conducted in a tertiary care cancer center in Uttarakhand in patients aged 1–18 years. Patients received one of the three 5-HT3 blockers, ondansetron, palonosetron, or granisetron, according to the choice of treating clinician in each chemotherapy cycle. Observations were made for breakthrough CINV, retching episodes, and the need for rescue medication. The assessment was done by the patient and attendants on a self-reporting scale and by the nursing staff based on CTCAE (ver 4.03) criteria. Results: Ondansetron was the most commonly used 5-HT3 blocker; used in 53% of the chemotherapy cycles. All three 5-HT3 blockers evaluated in this study, showed efficacy in preventing acute CINV. However, granisetron was inferior based on the self-reporting scale. The nursing assessment showed better control of acute CINV with palonosetron in terms of grade and number of breakthrough CINV episodes (p

Abstract Introduction Non‐inferiority of NEPA (fixed combination of NK1 receptor antagonist (RA), netupitant, and 5‐HT3RA, palonosetron) versus an aprepitant regimen was previously shown in a pragmatic study in patients receiving anthracycline cyclophosphamide (AC) and non‐AC moderately emetogenic chemotherapy (MEC). In the MEC group a numerically higher complete response (CR: no emesis, no rescue) rate was seen for NEPA during the overall 0–120 h phase (NEPA 76.1% vs. 63.1% aprepitant). As NEPA exhibits long‐lasting efficacy, this study evaluated a prolonged period up to 144 h, beyond the traditional 120 h post‐chemotherapy. In this post‐hoc analysis we explore the comparative efficacy of NEPA versus the aprepitant regimen in the MEC group up to 144 h, while also assessing the impact of risk factors on CINV prevention. Methods This was a pragmatic, multicenter, randomized, prospective study. Oral NEPA was administered as a single dose on day 1, while aprepitant was given on days 1–3 + ondansetron on day 1; all patients were to receive dexamethasone on days 1–4. Patients were chemotherapy‐naïve and receiving MEC, with a subset evaluation of those with a risk factor for developing CINV (i.e., female, male

AbstractBackground Butorphanol has been used to reduce the incidence and severity of neuraxial morphine-induced pruritus. Palonosetron is a commonly used antiemetic for the prevention of postoperative nausea and vomiting. The aim of our study was to compare the effective dose in 50% of subjects (ED50) of intravenous butorphanol infusion with or without a single intravenous bolus of palonosetron for preventing pruritus induced by epidural administration of morphine.Methods A total of 120 parturients were randomly assigned to receive an intravenous bolus injection of palonosetron plus continuous infusion of butorphanol (Group P + B) or an intravenous bolus of saline plus continuous infusion of butorphanol (Group B) after epidural administration of morphine. The antipruritic effect was graded as satisfactory (numerical rating scale (NRS) of pruritus ≤3) or unsatisfactory (NRS >3) within 48 h after morphine treatment. The first patient in each group received butorphanol infusion at a rate of 4 µg/kg/h. The infusion dose for each subsequent patient in the corresponding group was increased by 0.2 µg/kg/h after an unsatisfactory response or decreased by 0.2 µg/kg/h after a satisfactory response. The ED50 was calculated for each group and compared using up-down sequential analysis.Results The ED50 (mean [95% confidence interval (CI)]) of the dose of intravenous butorphanol infusion for preventing moderate to severe pruritus was lower in Group P + B (3.29 µg/kg/min [3.25–3.34 µg/kg/min]) than in Group B (3.57 µg/kg/min [3.47–3.67 µg/kg/min]) (p

Background. Propofol is widely used for induction, maintenance of anaesthesia and possess many characteristics of an ideal intravenous anaesthetic agent. It is known to cause severe, sharp, stinging or burning pain on injection which is considered to be unacceptable as it can cause agitation and interfere with smooth induction of anaesthesia. In this study we are comparing Palonosetron and Normal Saline in decreasing pain on injection of propofol during intravenous induction of anaesthesia. Material and methods. One hundred adult patients belonging to ASA physical status I or II, scheduled for elective surgeries under general anaesthesia were selected and randomly allocated to two groups. Group P received Injection Palonosetron and Group S received Injection Normal Saline as pre-treatment before injection of propofol. Patients were assessed for pain on propofol injection. Haemodynamic parameters and electrocardiography were recorded at the following points of time: prior to induction, after pre-treatment,induction, and half hourly during the surgery. Results. Comparing pain during propofol injection, 32% in Palonosetron group and 4% in Normal Saline group did not have pain, 54 % in Palonosetron group and 20 % in Normal Saline group had mild pain, 12% in Palonosetron group and 48% in Normal Saline group had moderate pain, 2% in Palonosetron group and 28% in Normal Saline group had severe pain. Conclusions. Pretreatment with Palonosetron 0.075 mg reduced the incidence and severity of propofol induced pain on injection, with an added advantage of decreased post-operative nausea and vomiting without significant haemodynamic changes.

Introduction: Dexamethasone (DEX)-sparing strategy with 5-hydroxytryptamine-3 receptor antagonist (5HT3RA) and aprepitant (APR), as triplet antiemetic prophylaxis, is associated with poor control of delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving carboplatin (CBDCA)-based chemotherapy. This study aimed to evaluate whether using palonosetron (PALO) as a 5HT3RA provides superior control with CINV than first-generation (1st) 5HT3RA in triplet antiemetic prophylaxis with a DEX-sparing strategy. Methods: Pooled patient-level data from a nationwide, multicenter, and prospective observational study were analyzed to compare the incidence of CINV between patients administered PALO and 1st 5HT3RA in combination with 1-day DEX and APR. Results: No significant differences were observed in the incidence of CINV, pattern of CINV, or severity of nausea by type of 5HT3RA in triplet antiemetic prophylaxis with DEX-sparing strategy. In both groups, the incidence of nausea gradually increased from day 3, peaked on day 4 or 5, and then declined slowly. The visual analog scale scores in the delayed phase remained high throughout the 7-day observation period. Conclusion: Careful patient selection and symptom monitoring are needed when implementing the DEX-sparing strategy in triplet antiemetic prophylaxis for patients undergoing CBDCA-based chemotherapy. Furthermore, additional strategies may be needed to achieve better control of delayed CINV. [ABSTRACT FROM AUTHOR]

Introduction: Non‐inferiority of NEPA (fixed combination of NK1 receptor antagonist (RA), netupitant, and 5‐HT3RA, palonosetron) versus an aprepitant regimen was previously shown in a pragmatic study in patients receiving anthracycline cyclophosphamide (AC) and non‐AC moderately emetogenic chemotherapy (MEC). In the MEC group a numerically higher complete response (CR: no emesis, no rescue) rate was seen for NEPA during the overall 0–120 h phase (NEPA 76.1% vs. 63.1% aprepitant). As NEPA exhibits long‐lasting efficacy, this study evaluated a prolonged period up to 144 h, beyond the traditional 120 h post‐chemotherapy. In this post‐hoc analysis we explore the comparative efficacy of NEPA versus the aprepitant regimen in the MEC group up to 144 h, while also assessing the impact of risk factors on CINV prevention. Methods: This was a pragmatic, multicenter, randomized, prospective study. Oral NEPA was administered as a single dose on day 1, while aprepitant was given on days 1–3 + ondansetron on day 1; all patients were to receive dexamethasone on days 1–4. Patients were chemotherapy‐naïve and receiving MEC, with a subset evaluation of those with a risk factor for developing CINV (i.e., female, male <60 years, male ≥60 years who received carboplatin, or male ≥60 years with anxiety). CR rates were compared during the extended overall (0–144 h) phase. Results: The MEC group included 211 patients; of these 181 were in the risk factor subset. Significantly higher CR rates were seen for NEPA than aprepitant during the extended overall phase for the total MEC group (NEPA 77.1%, aprepitant 57.8%, p = 0.003) and also in the subset of patients with CINV risk factors (NEPA 73.9%, aprepitant 56.2%, p = 0.012). Conclusion: A single dose of NEPA, administered on day 1 only, was more effective than a 3‐day aprepitant regimen in preventing CINV for an extended duration in patients receiving MEC and in those with emetic risk factors. [ABSTRACT FROM AUTHOR]

Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients. In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n =84) or normal saline (n =86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionnaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3. The incidence of a complete response until POD 2 was 48% (n =32) in the palonosetron group and 36% (n =25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85–3.37]; P =0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P =0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P =0.033) and POD 2 (9% vs 27%; P =0.007). No differences were observed on POD 3 (15% vs 13%; P =0.700). Compared with placebo, palonosetron did not reduce the overall incidence of post-discharge nausea and vomiting up to postoperative day 2. The lower incidence of post-discharge nausea and vomiting on poatoperative days 1 and 2 in the palonosetron group requires further investigation. EudraCT 2015-003956-32. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) is a common complication following surgical procedures, impacting patient recovery and satisfaction. This clinical trial aimed to compare the efficacy of palonosetron and ondansetron for PONV prevention, considering their safety profiles, patient satisfaction, and perioperative outcomes. Methods: A prospective, randomized, double-blind, controlled clinical trial enrolled patients undergoing elective surgery under general anesthesia. Patients were assigned to receive either palonosetron or ondansetron. The primary outcome was the incidence of PONV within 24 hours postoperatively. Secondary outcomes included time to first nausea and vomiting, adverse events, patient satisfaction, postoperative pain scores, and time to ambulation. Statistical analyses were employed to assess the differences between treatment groups. Results: Among the 300 patients (150 per group), palonosetron demonstrated a significantly lower incidence of PONV within 24 hours compared to ondansetron (10.7% vs. 24.0%, p < 0.001). The palonosetron group exhibited a prolonged time to first nausea and vomiting (p < 0.001 for both). Adverse events were comparable between groups, and patient satisfaction scores trended higher with palonosetron. Postoperative pain scores were lower (p = 0.013) and time to ambulation was shorter (p = 0.029) in the palonosetron group. Conclusion: This clinical trial highlights the superior efficacy of palonosetron over ondansetron in preventing PONV during the immediate postoperative period. Palonosetron's extended antiemetic effect, coupled with favorable safety and patient-centered outcomes, underscores its potential as a preferred antiemetic choice. These findings contribute to evidence-based perioperative practices, enhancing patient care and recovery. [ABSTRACT FROM AUTHOR]