CLINICAL TRIAL article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1549619
Palonosetron versus Tropisetron with Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Pediatric Adenotonsillectomy: A Single Center, Randomized Controlled Trial
Provisionally accepted
- Department of Anesthesiology, Shanghai Children’s Medical Center, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Postoperative nausea and vomiting (PONV) remain significant complications following pediatric adenotonsillectomy. Although palonosetron, a second-generation 5-HT3 receptor antagonist, has shown potential for preventing PONV, further research is needed to assess its efficacy when combined with dexamethasone in pediatric otolaryngologic procedures. This study aims to observe the efficacy of palonosetron or tropisetron combined with dexamethasone in preventing PONV in children undergoing adenotonsillectomy. Methods: We enrolled 110 children scheduled for elective adenotonsillectomy under general anesthesia. Based on a computer-generated random number table, children were assigned in equal proportions to receive either palonosetron or tropisetron. The P-group received palonosetron (1 2 / 18 µg/kg, maximum 50 µg), while the T-group received tropisetron (0.1 mg/kg, maximum 2 mg) 5 minutes before anesthesia induction. After receiving their allocated drug, children received intravenous dexamethasone (0.15 mg/kg, maximum 5 mg) during induction. Primary outcomes included PONV incidence at 6, 24, and 48 hours postoperatively. Secondary outcomes included the number of children with PONV scores of 1, 2, and 3, rescue antiemetic medication, and adverse events. Results: A total of 110 children (aged 3-12 y, ASA physical status 1 or 2, weighted 14.3-47.3 kg) were enrolled in the study between December 2021 and July 2023. The P-group (n=52) demonstrated significantly lower PONV incidence than the T-group(n=51) during the 0-48 hours (5.8% vs. 25.5%, P<0.05). Notably, this difference was most pronounced during the first 24 hours: 0-6 hours (0% vs. 10%, P<0.05) and 6-24 hours (3.8% vs. 7.8%, P<0.05). The difference during 24-48 hours was insignificant (4% vs. 8%, P>0.05). Transient junctional rhythm occurred in three patients receiving tropisetron, which did not affect circulation. Headache and dizziness were similar between groups within 48 hours (P-group: 3.8%, T-group: 7.8%, P >0.05). Conclusion: In paediatric adenotonsillectomy, palonosetron with dexamethasone gives better PONV prevention than tropisetron with dexamethasone, especially in the first 24 hours, with comparable safety.
Keywords: PONV, Palonosetron, Tropisetron, Children, adenotonsillectomy, Clinical Trial Registration: ChiCTR2100046848
Received: 21 Dec 2024; Accepted: 20 Mar 2025.
Copyright: © 2025 Chen, Sun, Zheng and Gu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongbin Gu, Department of Anesthesiology, Shanghai Children’s Medical Center, Shanghai, 200000, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.