Efficacy of Ondansetron Versus Palonosetron for Postoperative Nausea and Vomiting in Abdominal Laparoscopic Surgeries: A Systematic Review

Verma, Krishika; Sharma, DK; Gupta, Mukesh; Gupta, Anant

doi:10.21608/asmj.2025.380977.1442

Efficacy of Ondansetron Versus Palonosetron for Postoperative Nausea and Vomiting in Abdominal Laparoscopic Surgeries: A Systematic Review

Document Type : Review Article

Authors

¹ department of anaesthesia vardhaman medical college and safdarjung hospital new delhi

² Head of Department, Department of Anesthesia, Paras Hospitals, Gurugram

³ Department of Anaesthesia and Critical Care, Paras Hospital, Gurgaon, Haryana, India

⁴ Dept of Hospital Administration, AIIMS New Delhi

10.21608/asmj.2025.380977.1442

Abstract

Background: Postoperative nausea and vomiting (PONV) remain among the most common and distressing complications following abdominal laparoscopic surgeries. They significantly affect patient satisfaction, recovery time, and healthcare costs. 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists such as ondansetron and palonosetron are widely used for PONV prophylaxis, yet their comparative efficacy remains an area of active research.
Objective: To systematically compare the efficacy and safety of ondansetron versus palonosetron for the prevention of PONV in patients undergoing abdominal laparoscopic surgeries.
Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane Library databases for studies published between 2000 and 2024. Inclusion criteria were randomized controlled trials (RCTs), systematic reviews, and meta-analyses comparing ondansetron and palonosetron in the context of PONV in abdominal laparoscopic surgeries. Outcomes assessed included incidence of early (0–6 hours) and late (6–72 hours) PONV, need for rescue antiemetics, and adverse effects.
Results: A total of 40 studies (n > 9,000 patients) were included. Palonosetron demonstrated significantly greater efficacy than ondansetron in reducing both early and delayed PONV. The requirement for rescue antiemetics was also lower in the palonosetron group. Additionally, palonosetron exhibited a more favorable safety profile, especially regarding QT interval prolongation.
Conclusion: Palonosetron is superior to ondansetron for PONV prophylaxis in abdominal laparoscopic surgeries, especially in high-risk patients and in cases where extended antiemetic coverage is required.

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