title: Transdermal scopolamine: an alternative to ondansetron and droperidol for the prevention of postoperative and postdischarge emetic symptoms.
abstract: BACKGROUND
  Given the controversy regarding the use of droperidol and the high cost of the 5-HT3 antagonists, a cost-effective alternative for routine use as a prophylactic antiemetic would be desirable. We designed two parallel, randomized, double-blind sham and placebo-controlled studies to compare the early and late antiemetic efficacy and adverse event profile of transdermal scopolamine (TDS) 1.5 mg, to ondansetron 4 mg IV, and droperidol 1.25 mg IV for antiemetic prophylaxis as part of a multimodal regimen in "at risk" surgical populations.
  
  
  METHODS
  A total of 150 patients undergoing major laparoscopic (n = 80) or plastic (n = 70) surgery procedures received either an active TDS patch (containing scopolamine 1.5 mg) or a similar appearing sham patch 60 min before entering the operating room. All patients received a standardized general anesthetic technique. A second study medication was administered in a 2-mL numbered syringe containing either saline (for the two active TDS groups), droperidol, 1.25 mg, or ondansetron, 4 mg (for the sham patch groups), and was administered IV near the end of the procedure. The occurrence of postoperative nausea and vomiting/retching, need for rescue antiemetics, and the complete response rates (i.e., absence of protracted nausea or repeated episodes of emesis requiring antiemetic rescue medication) was reported. In addition, complaints of visual disturbances, dry mouth, drowsiness, and restlessness were noted up to 72 h after surgery.
  
  
  RESULTS
  There were no significant differences in any of the emetic outcomes or need for rescue antiemetics among the TDS, droperidol, and ondansetron groups in the first 72 h after surgery. The complete response rates varied from 41% to 51%, and did not significantly differ among the treatment groups. The overall incidence of dry mouth was significantly more frequent in the TDS groups than in the droperidol and ondansetron groups (21% vs 3%).
  
  
  CONCLUSIONS
  Premedication with TDS was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9068, USA. paul.white@utsouthwestern.edu
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Jun
authors.initials: J
authors.lastname: Tang
authors.forename: Dajun
authors.initials: D
authors.lastname: Song
authors.forename: Jayne E
authors.initials: JE
authors.lastname: Coleman
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
authors.forename: Babatunde
authors.initials: B
authors.lastname: Ogunnaike
authors.forename: Alexander
authors.initials: A
authors.lastname: Sloninsky
authors.forename: Rajani
authors.initials: R
authors.lastname: Kapu
authors.forename: Mary
authors.initials: M
authors.lastname: Shah
authors.forename: Tom
authors.initials: T
authors.lastname: Webb
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000627:therapeutic use; D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D050110:Bariatric Surgery; D004311:Double-Blind Method; D004329:Droperidol / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D016462:Mammaplasty; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D019651:Plastic Surgery Procedures; D012601:Scopolamine / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D000759:Adjuvants, Anesthesia; D000932:Antiemetics; D017294:Ondansetron; D012601:Scopolamine; D004329:Droperidol