Learning Objective #1: Understand the risk factors associated with nausea and vomiting

Learning Objective #2: Discuss the different treatment modes for postoperative nausea and vomiting

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Risk factors have been identified which place a patient at a greater risk for developing postoperative nausea and vomiting (PONV). The purpose of this study was to determine if using a combination of TD scopolamine and IV ondansetron would be more efficacious in preventing PONV in a group of patients who are at high risk for PONV when compared to a similar group given IV ondansetron alone. This randomized, double blind trial was performed on 56 ASA I and II patients who were identified as high risk for the development of PONV. Prior to surgery all subjects randomly received either a transdermal scopolamine or placebo patch in addition to intravenous ondansetron. A significant difference was noted between the scopolamine (385 minutes) and the placebo (240 minutes) in the time until they experienced their first episode of nausea (p=0.032) and in the time of first emesis (498 minutes versus 324 minutes, respectively) (p=0.031). Subjects in the scopolamine group also required significantly less antiemetic treatment as compared to the placebo group while in the PACU or SDSU (9 versus 18 respectively) (p=0.016). VNRS scores for nausea were also noted to be significantly different between the groups at multiple time intervals (p< 0.05). It was also noted that those in the scopolamine group had a significantly lower incidence of PONV following discharge than the placebo group (1 versus 6, respectively) (p=0.043). This simple application of TD scopolamine has been shown to significantly reduce the incidence and severity of PONV in a group of patients who were at high risk for the development of PONV. This translated into a significant reduction in workload requirements for nursing personnel as well as an increase in overall patient comfort.