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

Abstract

BackgroundPostoperative 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.Methods120 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.ResultsThe 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.ConclusionsThe 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.

Perspectives on transdermal scopolamine for the treatment of postoperative nausea and vomiting

“…Overall, in the first 24 hours after surgery nausea rates were 17.5% for transdermal scopolamine patients, 55.0% for dexamethasone-only patients, and 50.0% for ramosetron patients. Five percent of transdermal scopolamine patients required rescue antiemetics compared with 35.0% of dexamethasone-only patients and 22.5% of ramosetron patients [54].…”

“…Further study of longer-term antiemetic effects of transdermal scopolamine (24 to 72 hrs) is warranted. Table 3 Overview of adverse events reported in clinical trials of transdermal scopolamine [28][29][30]43,[45][46][47][48][49][50][51][52][53][54][55][56] Study Surgery N Design Adverse events Bailey et al [45] Outpatient laparoscopy 138 TDS vs placebo AEs mild but more frequent in TDS than placebo pts (91% vs 45%, P b 0.05). Einarsson et al [46] GYN laparoscopy 48 TDS vs placebo AEs mild.…”

“…Furthermore, the multiple (and possibly interactive) targets of scopolamine actions (both peripheral and central) complicate the direct relationship between effect and blood concentration. Supporting this view: first, the pharmacokinetics of transdermal scopolamine are best modeled by a multi-compartment model rather than a Table 2 Overview of several studies evaluating the efficacy of transdermal scopolamine for postoperative nausea and vomiting or postdischarge nausea and vomiting (PONV/PDNV) prophylaxis [28][29][30]43,[45][46][47][48][49][50][51][52][53][54][55][56] single-compartment model [41] and, second, there is considerable variability in plasma concentration among individuals who respond to the drug. For instance, in one typical study, the mean plasma concentration of scopolamine in those experiencing an antiemetic effect had a standard error that was nearly half as large as the mean itself (157 ± 77 pg/ mL) [42].…”

“…One hundred twenty patients undergoing major orthopedic surgery were given IV dexamethasone 8 mg after placement of spinal anesthesia [54]. One group of patients received no other treatment, a second group received a transdermal scopolamine patch, and the third group received IV ramosetron 0.3 mg at the end of surgery.…”

Impacto Da Saída Precoce Do Leito Na Artroplastia Total De Joelho

“…Por conta disso, torna-se fundamental o manejo individualizado da dor, com o uso de técnicas analgésicas adequadas como a crioterapia, utilizada em nosso protocolo institucional 19,20 . Além disso, a reabilitação precoce, com foco em acelerar a recuperação pós-operatória, pode reduzir o tempo de internação hospitalar e o retorno às atividades de vida diária 21,22 . Já a falta de prescrição de fisioterapia entre os grupos não teve diferença significante.…”