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AMBULATORY ANESTHESIA

Transdermal Scopolamine: An Alternative to Ondansetron and Droperidol for the Prevention of Postoperative and Postdischarge Emetic Symptoms

Paul F. White, PhD, MD^*, Jun Tang, MD, Dajun Song, MD, PhD^*, Jayne E. Coleman, MD^*, Ronald H. Wender, MD, Babatunde Ogunnaike, MD^*, Alexander Sloninsky, MD, Rajani Kapu, MD^*, Mary Shah, MD^*, and Tom Webb, MD

From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and Department of Anesthesiology, Cedars Sinai Medical Center in Los Angeles, Los Angeles, California.

Address correspondence and reprint requests to Paul F. White, PhD, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5161 Harry Hines Boulevard, CS 2. 282, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu.

BACKGROUND: Given the controversy regarding the use of droperidol and the high cost of the 5-HT₃ antagonists, a cost-effective alternative for routine use as a prophylactic antiemetic would be desirable. We designed two parallel, randomized, double-blind sham and placebo-controlled studies to compare the early and late antiemetic efficacy and adverse event profile of transdermal scopolamine (TDS) 1.5 mg, to ondansetron 4 mg IV, and droperidol 1.25 mg IV for antiemetic prophylaxis as part of a multimodal regimen in "at risk" surgical populations.

METHODS: A total of 150 patients undergoing major laparoscopic (n = 80) or plastic (n = 70) surgery procedures received either an active TDS patch (containing scopolamine 1.5 mg) or a similar appearing sham patch 60 min before entering the operating room. All patients received a standardized general anesthetic technique. A second study medication was administered in a 2-mL numbered syringe containing either saline (for the two active TDS groups), droperidol, 1.25 mg, or ondansetron, 4 mg (for the sham patch groups), and was administered IV near the end of the procedure. The occurrence of postoperative nausea and vomiting/retching, need for rescue antiemetics, and the complete response rates (i.e., absence of protracted nausea or repeated episodes of emesis requiring antiemetic rescue medication) was reported. In addition, complaints of visual disturbances, dry mouth, drowsiness, and restlessness were noted up to 72 h after surgery.

RESULTS: There were no significant differences in any of the emetic outcomes or need for rescue antiemetics among the TDS, droperidol, and ondansetron groups in the first 72 h after surgery. The complete response rates varied from 41% to 51%, and did not significantly differ among the treatment groups. The overall incidence of dry mouth was significantly more frequent in the TDS groups than in the droperidol and ondansetron groups (21% vs 3%).

CONCLUSIONS: Premedication with TDS was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.

This article has been cited by other articles:

				V. Chinnappa and F. Chung Post-discharge nausea and vomiting: an overlooked aspect of ambulatory anesthesia?/Nausees et vomissements apres le conge : un aspect neglige de l'anesthesie ambulatoire ? Can J Anesth, September 1, 2008; 55(9): 565 - 571. [Full Text] [PDF]

				P. F. White, J. F. O'Hara, C. R. Roberson, R. H. Wender, K. A. Candiotti, and The POST-OP Study Group The Impact of Current Antiemetic Practices on Patient Outcomes: A Prospective Study on High-Risk Patients Anesth. Analg., August 1, 2008; 107(2): 452 - 458. [Abstract] [Full Text] [PDF]

				P. F. White, O. Sacan, N. Nuangchamnong, T. Sun, and M. R. Eng The Relationship Between Patient Risk Factors and Early Versus Late Postoperative Emetic Symptoms Anesth. Analg., August 1, 2008; 107(2): 459 - 463. [Abstract] [Full Text] [PDF]

				P. S. A. Glass and P. F. White Practice Guidelines for the Management of Postoperative Nausea and Vomiting: Past, Present, and Future Anesth. Analg., December 1, 2007; 105(6): 1528 - 1529. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999