Effect of Transdermal Scopolamine for the Prevention of Postoperative Nausea and Vomiting Associated With Robotic Gynecologic Surgery: A Randomized,Double-Blinded,Placebo-Controlled Trial

Abstract

Abstract

Objective: To evaluate the efficacy of transdermal scopolamine for treatment of postoperative nausea and vomiting (PONV) after robotic-assisted gynecologic surgery. Design: Prospective, randomized, double-blinded, placebo-controlled clinical trial. Method: Overall, 47 patients underwent robotic-assisted gynecologic surgery at two tertiary care hospitals, and they were randomized to receive transdermal scopolamine or placebo preoperatively. They then completed a series of questionnaires utilizing a visual analogue scale to rate their nausea and vomiting. Main outcomes were severity of nausea and vomiting till 72 hours postoperatively. Secondary outcomes were antiemetic use, time to discharge, effect on patient well-being of PONV, and patient overall well-being. Results: There was a benefit to the number of rescue antiemetics administered in the immediate postoperative period (0.30 vs. 0.70, p=0.026), but no significant reduction in incidence or severity of PONV, no overall decrease in amount of antiemetics used, no change in length of hospital stay, and no impact on patient well-being with use of scopolamine. Conclusion: Rates of PONV in this robotic population of patients using multi-modality therapy are less than 40%. Further studies are needed to investigate the use of transdermal scopolamine for prevention of PONV after robotic-assisted gynecologic surgery, as the only significant benefit of its use compared with placebo was a reduction in the number of rescue antiemetics administered in the first 6 hours postoperatively. (J GYNECOL SURG 31:266)