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Transdermal Scopolamine Provides 24-h Relief of Postoperative Nausea and Vomiting: Presented at ASA
By W. A. Thomasson, PhD
CHICAGO, IL -- October 20, 2006 -- A transdermal scopolamine patch provides effective relief of postoperative nausea and vomiting (PONV) for at least 24 hours, according to data from a study presented here at the American Society of Anesthesiologists (ASA) 2006 Annual Meeting.
Neera Say, MD, assistant professor, department of anesthesiology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, presented the findings on behalf of first author Vimala Ramesh, MD, and colleagues at UPMC.
The researchers evaluated 85 patients undergoing cosmetic surgery who had at least 3 of 4 standard risk factors for PONV: female gender, history of PONV or motion sickness, current nonsmoker, and postoperative use of opioids. All patients underwent surgery under general anesthesia with intraoperative administration of ondansetron 4 mg as a preemptive antinausea agent.
The researchers gathered postoperative data on vital signs, pain and nausea on a 10-point visual analog scale (VAS), presence of emesis, treatment for pain, nausea and vomiting, side effects of scopolamine such as dry mouth, visual changes, agitation, and sedation.
Patients were randomly divided into 2 groups: 41 received a transdermal scopolamine patch 2 hours preoperatively, and 44 received a placebo patch at the same time. Nausea scores on VAS were collected hourly during postoperative hospital stay at about 3 hours and noted by the patient at 4-hour intervals following discharge.
Nausea scores during hospital stay were modest (0.50 to 1.50) and not significantly different between groups. However, nausea scores were significantly higher in the placebo group during the 24 hours after discharge from hospital. One patient in the scopolamine group and 3 in the placebo group had hospital admissions for uncontrollable nausea; there were 2 episodes of vomiting, both in the placebo group. Dry mouth was the most frequent adverse effect.
The absence of a significant difference between groups might be a reflection of the intraoperative administration of ondansetron, the researchers suggested. Other physicians, however, suggested that an additional factor may be the timing of patch application -- 4 to 6 hours is required for the patch to achieve maximum effect.
Nevertheless, transdermal scopolamine clearly reduced nausea during the 24 hours of hospital discharge. The authors stated that this could reduce patient discomfort and rates of hospital readmission.
[Presentation title: Evaluate Efficacy of Trans-Dermal Scopolamine in Prevention of PONV in Ambulatory Cosmetic Surgery. Abstract 1592]
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