Transdermal Scopolamine for the Reduction of Postoperative Nausea in Outpatient Ear Surgery

Abstract

We evaluated the effect of transdermal scopolamine on the incidence of postoperative nausea and vertigo after outpatient ear surgery (exploratory tympanotomy, mastoidectomy, or endolymphatic sac and oval and round window surgery) in a double-blind, placebo-controlled study. A transdermal patch containing either scopolamine (n = 19) or placebo (n = 20) was placed behind the nonsurgical ear 2 h before surgery. Anesthesia was induced with thiopental (4-6 mg/kg intravenously [i.v.]), sufentanil (0.5 microgram/kg i.v.), and vecuronium (0.1 mg/kg i.v.) and maintained with isoflurane (0.2%-2%) and nitrous oxide (70%) in oxygen. Patients were observed postoperatively in the recovery room and after discharge for 72 h. There was no significant difference between groups with respect to time in recovery room, time to discharge, incidence of in-house nausea, vomiting, amount of antiemetics required, or postoperative visual analog scale (VAS) scores while in the hospital. After discharge, there were lower VAS nausea scores (by repeat measures analysis, P < 0.05) and a lower reported incidence of nausea (31% vs 62%; P < 0.05) and vertigo (6.2% vs 25%; P < 0.05) in the active patch group versus the placebo group. There was a higher incidence of dry mouth in the active patch group (44% vs 25%). Seven patients did not complete the study due to failure to keep the patch in place or failure to return the diary from home; and one patient from the placebo patch group was admitted for uncontrolled nausea and vomiting. The authors concluded that transdermal scopolamine is effective in reducing, but not eliminating, postoperative nausea and vertigo after discharge in outpatient ear surgery.

Retracted: Prophylactic anti‐emetic therapy with granisetron, droperidol and metoclopramide in female patients undergoing middle ear surgery

“…Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events after general anaesthesia and surgery [1] and patients who undergo middle ear surgery may be especially at risk of experiencing these problems. In the absence of any anti-emetic treatment, the incidence of PONV following middle ear surgery ranges from 62% to 80% [2,3]. We have recently demonstrated that granisetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, reduces the incidence of PONV after middle ear surgery [4].…”

“…In the absence of any anti-emetic treatment, the incidence of PONV following middle ear surgery ranges from 62% to 80% [2,3]. We have recently demonstrated that granisetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, reduces the incidence of PONV after middle ear surgery [4].…”

Randomized Double Blind Comparative Study Comparing Efficacy of Granisetron and Ondansetron for the Prophylactic Control of Postoperative Nausea and Vomiting in Patients Undergoing Middle Ear Surgery

“…Honkavaara et al [1] and Reinhart et al [2] observed the incidence of PONV was as high as 60-80% in patients undergoing general anaesthesia for middle ear surgery. This incidence may justify the use of prophylactic antiemetics for the prevention of PONV after middle ear surgery [6,7].…”

“…Postoperative nausea and vomiting (PONV) occur frequently after middle ear surgery, with an incidence as high as 80% when no prophylactic antiemetic is given [1,2]. This can cause significant patient discomfort, electrolyte disturbances, and may lead to delay in resumption of normal activities after elective surgery.…”

Nausea and vomiting after ENT surgeries: A comparison between ondansetron, metoclopramide and small dose of propofol

“…This shows very high susceptibility of these patients for postoperative vomiting. The cause of vomiting after middle ear surgery is not known but many factors play their role including patients demography, history of motion sickness, anesthetic used [11,12]. Thus probably more effective antiemetic will be required for these surgeries such as combination of ondansetron and dexamethasone (Fujii et al 1998) [6].…”