Transdermal scopolamine for the prevention of postoperative nausea and vomiting: A systematic review and meta-analysis

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

“…The recommended patch application on the night before surgery [15] may not be practical in all clinical situations. A metaanalysis of 25 studies (n=3,298) found the relative risk for postsurgical nausea and postsurgical vomiting to be 0.56 and 0.54, respectively, when the patch was applied the day before surgery [14]. When the patch was applied later, such as roughly two hours before surgery, as some studies report, the relative risks were 0.61 and 0.74, respectively.…”

“…In that meta-analysis, 17 of 100 patients who would have suffered PONV without transdermal scopolamine would not have done so because of the patch [44]. A more recent metaanalysis, by Apfel et al, reported that transdermal scopolamine was associated with a significantly reduced rate of postoperative nausea versus placebo (relative risk = 0.77, 95% CI, 0.61 -0.98, P = 0.03) and significantly lowered PONV in the first 24 hours after the start of anesthesia (relative risk = 0.73, 95% CI, 0.60 -0.88, P = 0.001) [14]. In the last two decades, many studies of transdermal scopolamine for PONV/PDNV prophylaxis have been conducted.…”

“…When the patch was applied later, such as roughly two hours before surgery, as some studies report, the relative risks were 0.61 and 0.74, respectively. The authors of this meta-analysis reported that both early and late patch applications were efficacious for PONV prophylaxis [14].…”

“…Efforts to prevent PONV/ PDNV may improve patient satisfaction with surgical procedures. This theory has renewed interest in PONV/PDNV prophylaxis [13], including transdermal scopolamine [14]. Transdermal scopolamine has been approved for PONV prevention in adults [15].…”

Effective use of transdermal drug delivery in children

“…On the other hand, relative to oral administration, scopolamine patches must be applied 5-6 h before travelling due to slow drug absorption. Scopolamine patches are considered effective to reduce post-operative nausea and vomiting (PONV) in adults but a systematic review of this area excluded children [108]. While transdermal scopolamine has been shown in reducing the incidence of PONV in children, the effectiveness is variable;…”