Comparison of Aprepitant Versus Aprepitant and Transdermal Scopolamine for Preventing Postoperative Nausea and Vomiting
Condition: Nausea; Vomiting
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      The purpose of this study is to compare the incidence of nausea, vomiting, need for rescue
      medication, prolonged PACU time, and unplanned hospital admission in patients with high risk
      for post-operative nausea and vomiting (PONV) treated with oral aprepitant with or without
      transdermal scopolamine preoperatively.
    

Detailed description: 
      Aprepitant, a selective antagonist of neurokinin-1 (NK-1) receptors, blocks the emetic
      effects of substance P. NK-1 receptors are found on vagal afferents in the gastrointestinal
      tract and in the nucleus tractus solitaries in the brain. Substance P action on the NK-1
      receptors in the central nervous system (CNS) is one of the final pathways to an emetic
      response.

      Scopolamine antagonizes muscarinic type 1 (M1) and histamine type 1 (H1) receptors in the
      CNS, hypothalamus, and vomiting center. The noradrenergic system is also suppressed resulting
      in a diminished response to vestibular stimulation. Surgical procedures, opioids, and
      movement postoperatively all stimulate the vestibular system making scopolamine effective
      prophylaxis for PONV.

      In adults undergoing general anesthesia with inhalational anesthetic agents, predictive risk
      factors for PONV include female sex, history of PONV or motion sickness, nonsmoking status,
      and the use of postoperative opioids. The frequency of PONV is 10% with zero, 21% with one,
      39% with two, 61% with three, and 79% with 4 risk factors. The type of surgery also plays a
      major role. High risk procedures include intrabdominal, laparoscopic, orthopedic, major
      gynecologic, thyroid, otolaryngological, neurosurgical, breast, and plastic surgery.

      Improving PONV prophylaxis would have a profound impact on patient care. Decreasing the
      incidence of nausea, vomiting, need for rescue medication, prolonged PACU time, and unplanned
      admissions is beneficial. Recent evidence suggests multiple drug therapy is superior to
      single agents. The correct preoperative treatment medication is instrumental in the outcome.
      This study compares the incidence of nausea, vomiting, need for rescue medication, prolonged
      PACU time, and unplanned hospital admission in patients with high risk for PONV treated with
      oral aprepitant with or without transdermal scopolamine preoperatively.
    

Intervention name(s): Aprepitant; Scopolamine
Intervention type(s): Drug; Drug
Intervention description(s): Aprepitant 40mg PO one time at least one hour prior to induction of anesthesia; Scopolamine transdermal applied to skin behind the ear one hour prior to surgery
Other intervention name(s): Emend; Scopace; Transdermal scopolamine
Intervention MeSH terms: Scopolamine; Aprepitant; Butylscopolammonium Bromide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: postoperative nausea and vomiting