Nausea prophylaxis using transdermal scopolamine in the setting of patient-controlled analgesia

Article Abstract:

Abdominal surgery often leads to nausea and vomiting in patients after they awaken, and the use of patient-controlled intravenous (IV) analgesia for pain relief is associated with these complications. One treatment to prevent nausea and vomiting (antiemetic treatment) is transdermal scopolamine therapy, in which the drug is applied via a patch placed behind the ear. The effectiveness of transdermal scopolamine was evaluated in 34 patients who, after undergoing elective intra-abdominal gynecologic surgery with general anesthesia, were randomly assigned to receive a patch (15 patients) or not receive a patch (19). Patients quantified their nausea and vomiting 10 minutes after arriving in the postanesthesia recovery room or when they first became able to answer questions; at this time, those assigned to receive the transdermal patch received it. They reported their nausea and vomiting scores on separate scales at 2, 4, 6, and 24 hours after the study's onset. The scores were a four-point scale, ranging from zero (no nausea or vomiting) to 3 (severe symptoms). All patients controlled their own morphine analgesia. Results showed a slightly greater incidence of nausea in the scopolamine patients than in the controls before the treatment started and through the four-hour time point. After this, the incidence was lower for scopolamine patients at all points, but not significantly. Nausea was most severe two hours after surgery for both groups. The group who did not receive the patch had increased nausea between the two- and four-hour point, while the scopolamine patients experienced a drop in severity after the first two hours. Vomiting scores declined significantly in the scopolamine group, compared with the no-patch group, beginning at the two-hour point. The physiological mechanisms for this effect are explained, as is the design of the scopolamine patch. No treated patient vomited after six hours had elapsed. The transdermal scopolamine patch seemed to be a useful antiemetic after intra-abdominal surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Transdermal medication, Transdermal drug delivery systems, Nausea, Gynecology, Operative, Gynecological surgery, Scopolamine

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Indwelling epidural catheters for pain control in gynecologic cancer patients

Article Abstract:

Treating severe pain is one of the most important things that can be done for patients suffering from terminal gynecologic cancer. Proper treatment can greatly enhance the quality of life for the remaining time these patients have. A few types of pain treatment are available, but the use of opiate drugs, such as morphine, is the predominant means for relieving the pain. This study examined using a method for delivering morphine to patients in which an epidural tube around the outer lining of spinal cord was implanted and connected to a port for delivering the morphine which was implanted in the chest wall. Such delivery should relieve pain more rapidly and produce fewer side effects. The treatment was used on seven patients suffering from terminal gynecologic cancer who had life expectancies of at least four weeks. All suffered pain in the lower back and pelvis, with two also suffering pain in the upper abdominal area. Results showed that pain control by this method was good to excellent for all patients. The two patients with upper abdominal pain did sometimes require supplemental pain treatment. No major side effects or complications from the treatments were seen. The tubes were used for up to 180 days. These results indicate that treating pain in cancer patients with an indwelling catheter can efficiently relieve the pain without causing undesirable side effects such as interference with mental functioning. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Care and treatment, Usage, Terminal care, Cancer, Cancer pain, Morphine

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Patient-controlled epidural analgesia during labor

Article Abstract:

The pain associated with labor can be treated with epidural injection of a pain-relieving drug (a form of regional anesthesia to the abdomen) by an anesthesiologist. A newer technique is patient-controlled epidural analgesia, in which patients decide when they need an additional amount of analgesic, up to safe limits and under the supervision of an anesthesiologist. Seventy-five women were studied to document the safety, effectiveness, drug usage, and patient satisfaction with patient-controlled epidural analgesia as compared with continuous-infusion epidural anesthesia; the patient-controlled group included 47 women, whereas the continuous-infusion group consisted of 28 women. One day after delivery, the patients completed a questionnaire which asked about pain relief, satisfaction with the anesthesia, and the patient's opinion of the anesthesiologist. Both groups reported excellent pain relief and a favorable perception of the anesthesiologist. Overall drug use, frequency of low blood pressure (hypotension), and delivery procedure were not different between the patient-controlled and continuous-infusion groups. These results suggest that patient-controlled epidural analgesia is safe, effective and well accepted by patients, and it may reduce the requirement for anesthesia staff. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Labor (Obstetrics), Peridural anesthesia, Epidural anesthesia, Anesthesia in obstetrics, Obstetrical anesthesia

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