A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients

• Published in: PloS one 2020-01, Vol.15 (1), p.e0227490-e0227490
• Main Authors: Gouveia de Araujo Ferreira, Nathalia, Cavalcanti, Ismar Lima, Assad, Alexandra Rezende, Barrucand, Louis, Braga, Estêvão Luiz Carvalho, Verçosa, Nubia
• Format: Article
• Language: English
• Subjects: Adjustment; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Anesthesia; Anesthesiology; Antiemetics; Antiemetics - therapeutic use; Antiemetics and antinauseants; Biology and Life Sciences; Blood pressure; Body mass; Body Mass Index; Body size; Body Weight; Breast; Breast - surgery; Cancer; Chemotherapy; Clinical trials; Dexamethasone; Dexamethasone - therapeutic use; Dose-Response Relationship, Drug; Double-Blind Method; Double-blind studies; Drug dosages; Female; Gastrointestinal agents; Glucocorticoids; Hospitals; Humans; Intravenous administration; Investigations; Medical personnel; Medical research; Medical societies; Medicine and Health Sciences; Middle Aged; Nausea; Nonsteroidal anti-inflammatory drugs; Obesity; Obesity - complications; Obesity - pathology; Palonosetron; Palonosetron - therapeutic use; Postoperative Nausea and Vomiting - epidemiology; Postoperative Nausea and Vomiting - pathology; Postoperative Nausea and Vomiting - prevention & control; Professional associations; Prospective Studies; Randomization; Remifentanil; Severity of Illness Index; Sugammadex; Surgery; Values; Vomiting; Women's health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227490

Postoperative nausea and vomiting (PONV) is a common postsurgical complication. Palonosetron is effective for PONV prevention at the usual dose of 75 μg, but the ideal dose for obese patients has not yet been investigated. The aim of this study was to compare body weight-adjusted and fixed doses of palonosetron for preventing PONV in obese female patients. We performed a prospective, randomized, double-blind trial involving 80 female patients, aged 18-80 years with an American Society of Anesthesiologists physical status of 2 and 3 and a body mass index (BMI) ≥ 30 kg m-2 who were scheduled to undergo elective breast surgery. Patients received an intravenous body weight-adjusted dose of palonosetron (1 μg kg -1, GI = 40 patients) or a fixed dose of palonosetron (75 μg, GII = 40 patients). All patients received dexamethasone (4 mg). The incidence of PONV, complete response rate (CR), severity of nausea and need for rescue antiemetics and analgesics were assessed at: 0-1 h, 1-6 h, 6-24 h and 24-48 h postoperatively. The mean (± SD) BMI was 35.0 (±5.2) kg m-2 for GI and 35.7 (±3.6) kg m-2 for GII. There was no significant difference between groups in PONV incidence, CR, severity of nausea, and need for rescue antiemetics or analgesics. The incidence of PONV for GI and GII was 15% and 27.5%, respectively, during the first 48 h (P = 0.17). A body weight-adjusted dose of palonosetron was as effective as 75 μg for preventing PONV for 48 h in obese female patients who underwent breast surgery. Hence, the fixed dose may be preferable to the body weight-adjusted dose.