Revisiting transdermal scopolamine for postoperative nausea and vomiting

Abstract

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) in ambulatory patients remain serious problems that affect a substantial subset of surgical patients. Guidelines recommend that patients be stratified for risk, and patients at moderate-to-high risk be administered prophylactic PONV/PDNV therapy. Risk stratification on the four-point Apfel scale assigns one point for each of the following: female sex, nonsmoking status, history of PONV or motion sickness, and the use of postoperative opioids. Patients who score 2 or higher are considered to be at moderate-to-high risk. Other risk factors have been evaluated and discussed in the literature, such as type and duration of surgery. Surprisingly, although PONV/PDNV is more common in the first 24 hours after anesthesia, it may occur for days following surgery, and so, continuous treatment is advantageous. Transdermal scopolamine is a well-established agent with a history of safety and efficacy for PONV/PDNV prevention. Scopolamine is an anticholinergic agent that is generally well tolerated; side effects tend to be mild to moderate. The most frequently reported side effects with transdermal scopolamine are visual disturbances and dry mouth. Once adhered to the skin, the patch administers an initial dose and then a continuous dose of medication over 72 hours. Transdermal scopolamine is easy to administer, safe, effective, and relatively cost-effective, and it should be considered as an important tool to help prevent PONV/PDNV, whether administered as monotherapy or in combination with other agent(s).