Double–blind comparison of transdermal scopolamine, droperidol and placebo against postoperative nausea and vomiting

Abstract

Since transdermal scopolamine (TS) seems effective against seasickness, we compared its antiemetic effect with intravenous droperidol (DHBP), our routine antidote for postoperative emesis. Ninety-six female patients (ASA I-II) scheduled for short-stay surgery were randomly allocated to three study groups after giving their informed consent. The three groups were as follows: TS adhesive, delivering 140 micrograms initially and 5 micrograms/h thereafter + placebo 0.5 ml i.v. 5 min before the end of surgery; transdermal placebo adhesive preoperatively + DHBP 0.5 ml (1.25 mg) i.v. 5 min before the end of surgery; transdermal placebo + 0.5 ml placebo i.v. as indicated above. Oxycodone i.m. and glycopyrrolate i.v. were given for premedication together with the test adhesive. Anaesthesia was induced with thiopental and maintained with nitrous oxide and oxygen, enflurane, vecuronium and fentanyl. Neostigmine and glycopyrrolate were administered for reversal. In the recovery room no differences in nausea or vomiting were observed between the groups. Sedation was significantly more marked (P less than 0.15-0.0001) after DHBP than after either TS or the given DHBP and 6% of those given the placebo (P less than 0.05). During the following 24 h nausea was reported more by the placebo patients (25) than by those on TS (20) or DHBP (15) (P less than 0.05). However, actual vomiting on the ward did not differ between the groups. Visual disturbances were more frequent after TS (P less than 0.01). We conclude that prophylactic transdermal scopolamine does not diminish postoperative emetic sequelae.

Prevention and Treatment of Postoperative Nausea and Vomiting

“…Scopolamine blocks impulses from the vestibular center to higher areas in the CNS, reticular activating formation and vomiting center. Scopolamine is believed to be effective by altering the CNS imbalance of norepinephrine and acetylcholine that occurs in patients with motion sickness [70,72]. Glycopyrrolate is a quaternary amine that does not cross the blood-brain barrier and as such does not appear to have antiemetic or antimotion sickness effects [71].…”

Nausea and vomiting in the postoperative patient‐controlled analgesia environment

“…Kaufmann et al [5] found that a single dose of the long-acting 5-HT 3 antagonist, tropisetron, was effective in reducing both the incidence and the intensity of nausea and vomiting for up to 18 h postoperatively. Tigerstedt et al [38] found that giving droperidol at the end of surgery was effective in reducing nausea but that applying a transdermal scopolamine patch was not. However, it has been suggested that the failure to see an effect in that study may have been due to inappropriate timing of the patch application [35].…”

Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting

“…40,46,50,53,54,59,61,83,84,88,96,98,105,107,109 Some trials reported late incidences of nausea or vomiting with placebo below the 40% or above the 80% boundary, respectively. 38,39,42,70,78,91,93 Data from these trials were excluded from the sensitivity analysis with truncated control event rates (Table IIa).…”