Transdermal scopolamine for the reduction of postoperative nausea in outpatient
ear surgery: a double-blind, randomized study.
Author(s): Reinhart DJ, Klein KW, Schroff E.
Affiliation(s): Department of Anesthesiology, University of Utah, McKay-Dee Hospital, Ogden
84409-0370, USA.
Publication date & source: 1994, Anesth Analg. , 79(2):281-4
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.
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