Transdermal Scopolamine for Prevention of Intrathecal Morphine-Induced Nausea and Vomiting After Cesarean Delivery

Harnett, Miriam; OʼRourke, Nollag; Walsh, Mary M; Carabuena, Jean Marie; Segal, Scott

doi:10.1213/01.ane.0000277494.30502.db

Cited by 58 publications

(46 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In patients undergoing ambulatory surgery, it was found a dose-dependent incidence of PONV in the post anesthesia care unit with fentanil systemically administered [25]. Intrathecal use o morphine results in increased incidence of PONV [26] and prophylaxis is highly recommended [27].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

Yin¹,

Bráz²,

Colares³

et al. 2017

OJAnes

View full text Add to dashboard Cite

Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed; Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia; and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of

show abstract

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

Yin¹,

Bráz²,

Colares³

et al. 2017

OJAnes

View full text Add to dashboard Cite

show abstract

“…New double-blind RCTs comparing transdermal scopolamine with placebo patch corroborates findings of reduced nausea and vomiting reported by the original Guidelines (Category A3-B evidence), with no differences reported in dizziness, drowsiness, fatigue, blurred vision, or dry mouth (Category A3-E evidence). 45,46 Dexamethasone. Meta-analyses of new double-blind RCTs comparing dexamethasone with placebo controls corroborate findings reported in the original Guidelines indicating that this antiemetic is effective in the prophylaxis of postoperative vomiting and reduced use of rescue antiemetics, and for the prophylaxis of nausea when higher doses are administered (Category A1-B evidence).…”

Section: A1-e Evidence)mentioning

confidence: 99%

Practice Guidelines for Postanesthetic Care

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Ondansetron or scopolamine was equally effective in reducing emesis with intrathecal morphine analgesia for Caesarean section, although scopolamine use was associated with more anticholinergic side effects (Harnett et al, 2007 Level II). The combination of ondansetron with either dexamethasone or droperidol had a better antiemetic effect after gynaecological surgery compared with droperidol plus dexamethasone (Sanchez-Ledesma et al, 2002 Level II); although dexamethasone plus droperidol was superior to either alone (Wu et al, 2007 Level II).…”

Section: Chaptermentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

View full text Add to dashboard Cite

Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

show abstract

Transdermal Scopolamine for Prevention of Intrathecal Morphine-Induced Nausea and Vomiting After Cesarean Delivery

Abstract: Scopolamine is an effective medication for prophylactic use in parturients receiving intrathecal morphine while undergoing cesarean delivery. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.

Cited by 58 publications

References 13 publications

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

Practice Guidelines for Postanesthetic Care

Safety of opioid patch initiation in Australian residential aged care

Contact Info

Product

Resources

About