Transdermal scopolamine for prevention of intrathecal morphine-induced nausea and vomiting after cesarean delivery

Anesth Analg. 2007 Sep;105(3):764-9. doi: 10.1213/01.ane.0000277494.30502.db.

Abstract

Background: Intrathecal morphine for cesarean delivery provides excellent postoperative analgesia but is associated with significant nausea and vomiting.

Methods: We compared the antiemetic efficacy of transdermal scopolamine, IV ondansetron, and placebo during the first 24 h postoperatively. Two-hundred forty women undergoing cesarean delivery under spinal anesthesia were randomly allocated, in a double-blind study design, to receive transdermal scopolamine 1.5 mg, ondansetron 4 mg, or placebo at the time of cord clamping.

Results: Our study showed that the overall rates for all emesis were 59.3% in the placebo group and were reduced to 40% in the scopolamine group and 41.8% in the ondansetron group. The greatest reduction in emesis in the scopolamine group when compared with placebo was in the 6-24 h time period.

Conclusion: Scopolamine is an effective medication for prophylactic use in parturients receiving intrathecal morphine while undergoing cesarean delivery. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Cutaneous
  • Analgesia, Obstetrical*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Antiemetics / administration & dosage*
  • Antiemetics / adverse effects
  • Cesarean Section*
  • Double-Blind Method
  • Female
  • Humans
  • Incidence
  • Injections, Intravenous
  • Injections, Spinal
  • Morphine / administration & dosage
  • Morphine / adverse effects*
  • Ondansetron / administration & dosage*
  • Ondansetron / adverse effects
  • Postoperative Nausea and Vomiting / chemically induced
  • Postoperative Nausea and Vomiting / epidemiology
  • Postoperative Nausea and Vomiting / prevention & control*
  • Pregnancy
  • Scopolamine / administration & dosage*
  • Scopolamine / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Analgesics, Opioid
  • Antiemetics
  • Ondansetron
  • Morphine
  • Scopolamine