Transdermal Scopolamine for Prevention of Intrathecal Morphine-Induced Nausea and Vomiting After Cesarean Delivery

Abstract

In Brief 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. IMPLICATIONS: We compared the postoperative antiemetic efficacy of scopolamine, ondansetron, and placebo in patients receiving intrathecal morphine undergoing cesarean delivery. The rates of all emesis were reduced by one-third by transdermal scopolamine (TDS) or ondansetron. Scopolamine is an effective medication for prophylactic use in these parturients. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.