PONV referred to as the big little problem or the little big problem after surgery or anaesthesia is one of the most common perioperative concerns with a relatively high incidence of up to 73 percent after craniotomy The incidence of PONV reaches 25 to 30 percent

often rising to 80 percent after general anaesthesia among patients without prophylactic intervention PONV in neurosurgical patients causes pain tachycardia aspiration patient discomfort intravascular volume depletion dehydration acid base disturbances and elecrolyte imbalances like symptomatic hyponatremia hypokalemia hypochloremia it may also lead to increase in intracranial pressure and wound dehiscence hematoma which may be deleterious to the patients therefore it is imperative that PONV be managed optimally for after elective craniotomy because effective treatments to prevent or manage post operative nausea and vomiting allow early mobilization early food intake and improve overall patient satisfaction it is of even more importance in neurosurgical patients as even mild to moderate PONV may raise confusion regarding features of raised intracranial pressure in the postoperative period

severe pharmacological interventions including anticholinergics antihistamines corticosteroids dopamine receptor antagonists and serotonin receptor antagonists for treating and preventing PONV have been assesed

the lack of sedative effects makes 5HT3 antagonists the gold standard drugs for PONV prophylaxis in craniotomies when postoperative clinical neurological assesments are required

To the best of our knowledge there are no studies that have evaluated and compared the antiemetic efficacy of ondansetron palonosetron and ramosetron after elective craniotomy 

Therefore we have undertaken this study and hypothesized that palonosetron and ramosetron would provide a greater clinical benifit than ondansetron in this surgical cohort