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Prevention of postoperative nausea and vomiting with transdermal hyoscine in children using patient-controlled
E Doyle1, G Byers, L R McNicol
1Department of Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
Transdermal hyoscine significantly reduced postoperative nausea and vomiting in children after abdominal surgery. However, it also increased sedation and dry mouth incidence in the treated group.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) are common complications following abdominal surgery in children.
- Effective PONV prophylaxis is crucial for pediatric surgical recovery.
- Patient-controlled analgesia (PCA) with morphine is often used for postoperative pain management.
Purpose of the Study:
- To evaluate the efficacy of transdermal hyoscine in preventing postoperative nausea and vomiting (PONV) in children undergoing abdominal surgery.
- To assess the impact of transdermal hyoscine on the incidence of sedation and dry mouth as side effects.
- To compare transdermal hyoscine with placebo in conjunction with PCA morphine for postoperative analgesia.
Main Methods:
- A randomized controlled trial involving 40 children aged 6-14 years undergoing abdominal surgery.
- Participants received general anesthesia with an extradural block.
- The treatment group received transdermal hyoscine (140 mcg loading dose, then 5 mcg/h), while the placebo group received a placebo for 48 hours post-operation.
- Both groups received PCA morphine for analgesia.
Main Results:
- A statistically significant reduction (P < 0.001) in the incidence of PONV was observed in the transdermal hyoscine group compared to the placebo group within the first 48 hours.
- The incidence of sedation was significantly higher (P < 0.02) in the hyoscine-treated group.
- Dry mouth occurred significantly more frequently (P < 0.01) in children receiving transdermal hyoscine.
Conclusions:
- Transdermal hyoscine is effective in reducing postoperative nausea and vomiting in pediatric patients undergoing abdominal surgery.
- The benefits of reduced PONV must be weighed against the increased risks of sedation and dry mouth.
- Further research may explore optimal dosing or alternative antiemetic strategies in this population.
Abstract:
We have studied 40 children aged 6-14 yr undergoing abdominal surgery under general anaesthesia with extradural block; they were allocated randomly to receive transdermal hyoscine (loading dose 140 micrograms, followed by 5 micrograms h-1) or placebo for the duration of postoperative analgesia with PCA morphine. There was a significant (P < 0.001) reduction in the incidence of postoperative nausea and vomiting in the treated group compared with the placebo group during the first 48 h after operation. The treated group also had a significantly increased incidence of sedation (P < 0.02) and dry mouth (P < 0.01).