Kotelko D M, Rottman R L, Wright W C, Stone J J, Yamashiro A Y, Rosenblatt R M
Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California 90048-1869.
Anesthesiology. 1989 Nov;71(5):675-8. doi: 10.1097/00000542-198911000-00009.
The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.
作者评估了透皮东莨菪碱（TDS）对择期剖宫产且术后接受硬膜外吗啡镇痛的健康患者的止吐特性。在麻醉给药前，203例患者在一侧耳后贴敷TDS或安慰剂研究贴片。所有患者静脉输注乳酸林格氏液，并硬膜外给予2.0%利多卡因加1:200,000肾上腺素用于手术麻醉。婴儿娩出后，通过硬膜外导管注射4mg硫酸吗啡。术后，由“盲法”观察者在术后2、4、6、8、10、24和48小时对患者的恶心、呕吐、干呕、疼痛缓解、瘙痒及不良反应进行评估。此外，记录所使用的药物。两组在疼痛的严重程度或发生率、镇痛或止痒药物的使用需求方面未发现差异。虽然两组在最初2小时内无差异，但在2至10小时的每个时间间隔内，使用TDS的患者恶心、呕吐和干呕明显少于安慰剂组患者。此外，TDS组所需的止吐药物较少。两组干呕或呕吐的频率无差异。两组的副作用均轻微且相当。作者得出结论，TDS可降低剖宫产且接受硬膜外吗啡镇痛患者的恶心和呕吐发生率。TDS持续用于止吐给药似乎是安全的。
