PMID- 21118734
OWN - NLM
STAT- MEDLINE
DCOM- 20110311
LR  - 20181201
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 32
IP  - 12
DP  - 2010 Nov
TI  - Transdermal scopolamine for the prevention of postoperative nausea and vomiting: 
      a systematic review and meta-analysis.
PG  - 1987-2002
LID - 10.1016/j.clinthera.2010.11.014 [doi]
AB  - BACKGROUND: Transdermal scopolamine (TDS) is a potential long-acting prophylactic 
      antiemetic initially developed to prevent motion sickness. TDS is a centrally 
      acting anticholinergic agent that was approved in 2001 by the US Food and Drug 
      Administration for the prevention of postoperative nausea and vomiting (PONV). 
      Although TDS has been reported to be clinically efficacious in the prevention of 
      PONV, several adverse events (AEs), such as sedation, dry mouth, blurred vision, 
      central cholinergic syndrome, and confusion (particularly in elderly patients 
      with mild cognitive impairment), are potential concerns. OBJECTIVE: The aim of 
      this study was to explore the efficacy and tolerability of TDS in the prevention 
      of PONV in adults. METHODS: A systematic search of PubMed, EMBASE, and the 
      Cochrane Library for randomized controlled trials in adults that compared the 
      effects of TDS and placebo on postoperative nausea, vomiting, and PONV was 
      conducted in March 2009, and an update was conducted in July 2010. Without any 
      language restrictions, a search with the following terms was performed: 
      postoperative, postoperative, postanesthe*, postanaesthe*, post-anesthe*, 
      post-anaesthe*, anesthesia, anaesthesia, surgery, surgeries, surgical, nausea, 
      vomiting, emesis, retching, scopolamine, and hyoscine. Identified studies were 
      then hand-searched for further relevant literature. RESULTS: Data from 25 
      randomized controlled trials were analyzed (N = 3298). In the postanesthesia care 
      unit, TDS was associated with a significantly reduced risk for postoperative 
      nausea compared with placebo (relative risk [RR] = 0.77; 95% CI, 0.61-0.98; P = 
      0.03). TDS was also associated with a significantly reduced risk for 
      postoperative nausea (RR = 0.59; 95% CI, 0.48-0.73; P < 0.001), postoperative 
      vomiting (RR = 0.68; 95% CI, 0.61-0.76; P < 0.001), and PONV (RR = 0.73; 95% CI, 
      0.60-0.88; P = 0.001) during the first 24 hours after the start of anesthesia. 
      TDS appeared to be effective compared with placebo in the prevention of 
      postoperative nausea when treatment was initiated the night before (early 
      application) (RR = 0.56; 95% CI, 0.41-0.75; P < 0.001) or on the day of surgery 
      (late application) (RR = 0.61; 95% CI, 0.47-0.79; P < 0.001). TDS was associated 
      with a higher prevalence of visual disturbances at 24 to 48 hours compared with 
      placebo (RR = 3.35; 95% CI, 1.78-6.32). Analyses of confusion and other AEs did 
      not show a significant association with TDS. CONCLUSIONS: In this systematic 
      review and metaanalysis, TDS was associated with significant reductions in PONV 
      with both early and late patch application during the first 24 hours after the 
      start of anesthesia. TDS was associated with a higher prevalence of visual 
      disturbances at 24 to 48 hours after surgery, but no other AEs, compared with 
      placebo.
FAU - Apfel, Christian C
AU  - Apfel CC
AD  - Perioperative Clinical Research Core, Department of Anesthesia and Perioperative 
      Care, University of California at San Francisco, San Francisco, California 94115, 
      USA. apfelc@anesthesia.ucsf.edu or apfel@ponv.org
FAU - Zhang, Kun
AU  - Zhang K
FAU - George, Elizabeth
AU  - George E
FAU - Shi, Serena
AU  - Shi S
FAU - Jalota, Leena
AU  - Jalota L
FAU - Hornuss, Cyrill
AU  - Hornuss C
FAU - Fero, Katherine E
AU  - Fero KE
FAU - Heidrich, Felix
AU  - Heidrich F
FAU - Pergolizzi, Joseph V
AU  - Pergolizzi JV
FAU - Cakmakkaya, Ozlem S
AU  - Cakmakkaya OS
FAU - Kranke, Peter
AU  - Kranke P
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antiemetics)
RN  - DL48G20X8X (Scopolamine)
SB  - IM
EIN - Clin Ther. 2010 Dec;32(14):2502
MH  - Administration, Cutaneous
MH  - Antiemetics/administration & dosage/adverse effects/*therapeutic use
MH  - Humans
MH  - Postoperative Nausea and Vomiting/chemically induced/*prevention & control
MH  - Scopolamine/administration & dosage/adverse effects/*therapeutic use
EDAT- 2010/12/02 06:00
MHDA- 2011/03/12 06:00
CRDT- 2010/12/02 06:00
PHST- 2010/09/21 00:00 [accepted]
PHST- 2010/12/02 06:00 [entrez]
PHST- 2010/12/02 06:00 [pubmed]
PHST- 2011/03/12 06:00 [medline]
AID - S0149-2918(10)00376-0 [pii]
AID - 10.1016/j.clinthera.2010.11.014 [doi]
PST - ppublish
SO  - Clin Ther. 2010 Nov;32(12):1987-2002. doi: 10.1016/j.clinthera.2010.11.014.