Abstract
Background: We performed this prospective double-blind randomized controlled trial to identify the effect of a preoperative prophylactic transdermal scopolamine (TDS) patch on postoperative nausea and vomiting (PONV) after retromastoid craniectomy with microvascular decompression (RMC-MVD). Methods: We recruited 38 patients undergoing RMC-MVD and randomized them into two groups: the TDS group (n = 19, application of the TDS patch) and placebo group (n = 19, application of a sham patch). Nausea (as a self-reported 100-mm visual analog scale (VAS) score; range, 0 (no nausea) to 10 (worst nausea)), vomiting, and the use of antiemetics were the primary endpoints. Results: There was no significant difference in terms of the incidence of PONV (73.7% in the TDS group and 78.9% in the placebo group; p = 1.00) between the groups. However, the mean nausea VAS score was significantly different at arrival to the general ward (0.93 ± 1.71 in the TDS group vs. 2.52 ± 2.85 in the placebo group; p = 0.046), and throughout the study period (0.03 ± 0.07 in the TDS group vs. 0.44 ± 0.71 in the placebo group; p = 0.029). Rescue antiemetics were more frequently used in the placebo group than in the TDS group (9 (47.4%) vs. 2 (10.5%), respectively; p = 0.029). The mean number of antiemetics used throughout the study period was significantly higher in the placebo group than in the TDS group (1.37 ± 2.19 vs. 0.16 ± 0.50, respectively; p = 0.029). Conclusions: The preoperative prophylactic use of a TDS patch was safe and effective in the management of PONV after RMC-MVD in terms of the severity of PONV and the use of rescue antiemetics.
Highlights
Postoperative nausea and vomiting (PONV) can be defined as the presence of nausea and vomiting during the first 24 hours after a surgical procedure [1]
retromastoid craniectomy with microvascular decompression (RMC-MVD) is an effective and safe surgical procedure for hyperactive dysfunctional cranial nerve syndromes such as hemifacial spasm (HFS) and trigeminal neuralgia (TN), which are usually caused by vascular compression [8,9]
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Summary
Postoperative nausea and vomiting (PONV) can be defined as the presence of nausea and vomiting during the first 24 hours after a surgical procedure [1]. To completely alleviate vascular compression, the involved cranial nerves should be dissected along the whole intracranial portion, including the root exit/entry zone (REZ) of each cranial nerve on the brainstem surface Because these neural structures are located close to the vestibular nerve and nucleus of the brainstem, it may be a natural phenomenon for RMC-MVD to be significantly associated with PONV [10]. These features related to surgical procedures suggest that PONV after RMC-MVD might have a different pathophysiology to other surgical procedures, including strabismus surgery, gynecological surgery, middle ear surgery, and breast surgery We performed this prospective double-blind randomized controlled trial to identify the effect of a preoperative prophylactic transdermal scopolamine (TDS) patch on postoperative nausea and vomiting (PONV) after retromastoid craniectomy with microvascular decompression (RMC-MVD). Conclusions: The preoperative prophylactic use of a TDS patch was safe and effective in the management of PONV after RMC-MVD in terms of the severity of PONV and the use of rescue antiemetics
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