The effect of transdermal scopolamine for the prevention of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70-80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. The guidelines restrict the use of dexamethasone, transdermal scopolamine, aprepitant, and palonosetron as rescue medication 6 h after surgery. In an effort to find a safer and reliable therapy for PONV, new drugs with antiemetic properties and minimal side effects are needed, and scopolamine may be considered an effective alternative. Scopolamine is a belladonna alkaloid, α-(hydroxymethyl) benzene acetic acid 9-methyl-3-oxa-9-azatricyclo non-7-yl ester, acting as a non-selective muscarinic antagonist and producing both peripheral antimuscarinic and central sedative, antiemetic, and amnestic effects. The empirical formula is C17H21NO4 and its structural formula is a tertiary amine L-(2)-scopolamine (tropic acid ester with scopine; MW = 303.4). Scopolamine became the first drug commercially available as a transdermal therapeutic system used for extended continuous drug delivery during 72 h. Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects.
Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital Miami, FL, USA.
María A
MA
Antor
Department of Anesthesiology, The Ohio State University Werner Medical Center Columbus, OH, USA.
Alberto A
AA
Uribe
Department of Internal Medicine, Riverside Methodist Hospital Columbus, OH, USA.
Natali
N
Erminy-Falcon
Department of Anesthesiology, The Ohio State University Werner Medical Center Columbus, OH, USA.
Joseph G
JG
Werner
Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital Miami, FL, USA.
Keith A
KA
Candiotti
Department of Medicine, The Johns Hopkins University School of Medicine Baltimore, MD, USA.
Joseph V
JV
Pergolizzi
Department of Anesthesiology, The Ohio State University Werner Medical Center Columbus, OH, USA ; Department of Neurological Surgery, The Ohio State University Medical Center Columbus, OH, USA.
Sergio D
SD
Bergese
antiemetic; nausea; pharmacodynamics; pharmacokinetics; postoperative; prophylaxis; transdermal scopolamine; vomiting