The effect of transdermal scopolamine plus intravenous dexamethasone for the prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is common complication of Patient-Controlled Analgesia (PCA) after surgery. The authors sought to determine whether a transdermal scopolamine (TDS) patch in combination with IV dexamethasone is more effective than IV dexamethasone alone or IV dexamethasone plus IV ramosetron for reducing PONV in patients receiving epidural PCA after major orthopedic surgery. METHODS: 120 patients that received epidural PCA with hydromorphone and ropivacaine after major orthopedic surgery under spinal anesthesia were allocated to 3 groups: Group D (n = 40) received IV dexamethasone 8 mg, Group DR (n = 40) received IV dexamethasone 8 mg plus IV ramosetron 0.3 mg, Group DS (n = 40) received IV dexamethasone 8 mg plus a TDS patch (Group DS, n = 40). Nausea and vomiting incidences, VAS for nausea, the use of additional antiemetics, and adverse effects (a dry mouth, blurred vision, drowsiness) during the first 24 hours postoperatively were subjected to analysis. RESULTS: The DS Group had a significantly higher rate of complete remission of PONV than the D and DR groups (82.5% vs 47.5%, and 50.0%, respectively), and had lower rates of nausea (17.5% vs 55.0%, and 50.0%), and vomiting (10.0% vs 50.0%, and 25.0%), and required less antiemetics (5.0% vs 35.0%, 22.5%) than group D and Group DR during the first 24 hours after surgery. Furthermore, no inter-group differences were observed with respect to adverse effects in the three groups. CONCLUSIONS: The prophylactic use of a TDS patch plus dexamethasone was found to be a more effective means of preventing PONV in patients that received epidural PCA after major orthopedic surgery than dexamethasone alone or dexamethasone plus ramosetron without adversely affecting side effects.

The Effects of a Preoperative Transdermal Scopolamine on the Postoperative Nausea and Vomiting after Outpatient Conization / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the major causes that delays patients discharge in outpatient surgery. A transdermal scopolamine patch (TSP) is effective in preventing PONV and covers PONV for a long duration (72 hr) even after discharge. Therefore, we evaluated PONV using TSP on outpatient conization cases. METHODS: Forty four patients scheduled for a conization due to cervical intraepithelial neoplasm were randomly divided into two groups. A Band-Aid(R) -like patch containing either scopolamine (22 patients in TSP group) or a placebo (22 patient in placebo group) was placed either mastoid area at the night before surgery. Anesthesia was induced with fentanyl (50 or 100ng) and thiopental (375 mg/kg) and maintained with enflurane (1 vol%) and nitrous oxide (60%) in oxygen. The study was performed in a double-blind placebo-controlled manner. RESULTS: Incidences of PONV (TSP group: 4.5%, placebo group: 18.2%), requirements of antiemetics (TSP group: 0%, placebo group: 4.5%), and discharge from the hospital (TSP group: 134.8 min, placebo group: 150.0 min) were not different from each other group. There were no severe complications associated with TSP. Total incidence of side effects was higher in the TSP group than the placebo group (TSP group: 59%, placebo group: 14%) (P < 0.05) but dry mouth (PST group: 41%, placebo group: 0%) of the PST group was the most frequent and only significant individual complication compared to the placebo group. CONCLUSIONS: TSP did not reduce PONV and induced frequent mild side effects especially dry mouth in conization patients.

The Effect of Transdermal Scopolamine Patch on Nausea and Vomiting after Epidural Injection of Morphine / 대한마취과학회지

Sixty patients, undergoing major gynecologic surgery with lumbar epidural anesthesia, were randomly selected 32 patients to apply a transdermal scopolamine patch (Kimite MyoungMoon, Korea) on the skin behind one ear. We were divided into 2 groups. Control group; epidural morphine 4mg were given and not applied scopolamine patch. Experimental group; epidural morphine 4mg were given and applied transdermal scopolamine patch on the skin behind her ear at the night before surgery. They were followed up for 3 days postoperatively and statistical analysis was done. There was a significant (p<0.05) reduction in nausea and vomiting between experimental group and control group. There was no significant incresed incidence in scopolamine side effects. However, despite receiving transderrnal scopolamine patch there was still a high incidence (43.8%) of nausea and vomiting.

Effect of Transdermal scopolamine Patch on Nausea or Vomiting Associated with General Anesthesia / 대한마취과학회지

To evaluate the efficacy of transdermal scopolamine patch in reducing nausea and vomiting associated with general anesthesia, we studied 60 healthy women undergoing major gynecologic surgery. The patients were divided into 2 groups. Each group was composed of 30 patients. Group I; not applied a transdermal scopolamine patch. Group II: applied one transdermal scopolamine patch on the skin behind her ear at the night before surgery. Anesthesia was induced by thiopental sodium(5 mg/kg) and succinylcholine(1.5 mg/kg) and maintained with fentanyl(3-6 ug/kg), enflurane(0.5-1.5 vol%) and nitrous oxide(50 vo1%) in oxygen. A comparison with Group I and Group II indicated that the transdermal scopolamine patch reduced the incidence of postoperative nausea or vomiting associated with general anesthesia significantly(Group I; 36.67%, Group II; 13.33%, p<0.05).