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Background: Post-operative nausea and vomiting (PONV)usually may be such an unpleasant experience that patients often rate it worse than postoperative pain. Concerning the high incidence of PONV after middle ear surgery, and as there is no previous study to assess and compare the preventive effect of palonosetron-dexamethasone and ondansetron plus dexamethasone on PONV. The current study to match the impact of palonosetron-dexamethasone and ondansetron-dexamethasone combination with PONV in patients of middle ear surgery. Material & Methods: This is a prospective study done on 50 ASA I and II patients undergoing middle ear surgery under general anesthesia at SK Government Medical college, Sikar, Rajasthan, India during 5 months period. Patients were randomly selected for two equal groups of 25 each. Group O - Ondansetron 8 mg + dexamethasone 8 mg intravenously before induction of anesthesia and Group P - Palonosetron 0.075 mg + dexamethasone 8 mg intravenously before induction of anesthesia. The primary outcome was the incidence and severity of nausea and vomiting experienced by each patient after surgery. This was recorded at the following three assessment periods: 0-2, 2-6, and 6-24 hours after surgery. Results: The incidence of nausea was 44% in group O and 16% in group P 24 hours postoperatively (p<0.05*). The incidence and severity of vomiting were not statistically significant between groups O and P during the study period. The incidence of vomiting was 28% in group O and 20% in group P 24 hours postoperatively (p>0.05). The overall incidence of PONV (0-24 hours postoperatively) was 36% in group O and 8% in group P (p<0.05*). Conclusion: We concluded that palonosetron-dexamethasone is simpler within the prevention of PONV with superior antiemetic efficaciousness within the initial 24 hours compared to ondansetron-dexamethasone.

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