ArticleCureus2026
Granisetron for Postoperative Nausea and Vomiting Prophylaxis in Microvascular Decompression Despite Prominent Non-serotonergic Emetic Pathways.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
Background Microvascular decompression (MVD) is associated with a high incidence of postoperative nausea and vomiting (PONV). Unlike in general surgery, where PONV is predominantly serotonin-mediated, MVD additionally activates non-serotonergic emetic mechanisms, including vestibular stimulation and direct brainstem perturbation. Whether selective 5-HT₃ receptor antagonists can effectively prevent PONV in MVD remains unclear. Materials and methods This retrospective, exploratory, quasi-experimental before-after study included 40 consecutive MVD patients at a single institution, divided into a granisetron group (n = 20; 1 mg intravenously at dural closure) and a control group (n = 20) based on an institutional protocol change. Primary outcomes included PONV incidence, nausea severity, vomiting episodes, and rescue antiemetic use. Results Using the predefined moderate-to-severe threshold (nausea severity score ≥4, vomiting, or rescue antiemetic use), the 24-hour PONV incidence was lower in the granisetron group than in the control group (35% vs. 80%), corresponding to an absolute risk reduction (ARR) of 45% and a relative risk reduction (RRR) of 56% (p = 0.010). At six hours, the granisetron group showed lower nausea severity scores (4.0 (0-6.0) vs. 8.5 (6.75-9.0); p = 0.002) and fewer vomiting episodes (0 (0-1.0) vs. 1 (0.75-2.0); p = 0.022). Early mobilization and oral intake were also improved. Because the analysis was exploratory and the sample size limited, the estimates should be interpreted as hypothesis-generating. Conclusions In this exploratory, single-center, quasi-experimental before-after study of 40 patients, prophylactic granisetron was associated with an RRR of 56% and an ARR of 45% (number needed to treat ≈ 2.2) for moderate-to-severe PONV following MVD, consistent with a substantial serotonergic contribution to PONV in this setting. The residual PONV rate of 35% suggests that non-serotonergic emetic mechanisms remain unaddressed. Given the small sample size and single-center design, these findings should be regarded as hypothesis-generating rather than confirmatory; nonetheless, they support the evaluation of multimodal antiemetic strategies and may inform the design of adequately powered future studies on optimal antiemetic strategies for MVD.
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