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A randomized controlled study evaluating the effectiveness of scopolamine patch application with transcutaneous point P6 stimulation for reduction of intra-cesarean nausea and vomiting.
Abstract Number: F3A-2
Abstract Type: Original Research
Nausea and vomiting (N&V) is an unpleasant physical condition experienced by nearly 80% of the parturients during cesearean section (CS)1 under combined spinal-epidural (CSE) anesthesia. Transdermal scopolamine patch, an antiemetic that is not transferred to the baby via breastmilk or placenta, has been reported to be effective in reducing post-operative N&V after cesarean section2. Howver, no randomized clinical trial has investigated its affects on reduction of intraoperative N&V. We conducted a randomized clinical trial to compare the effectiveness of reducing intra-CS N&V with CSE in subjects who receive the transdermal scopolamine patch versus those that received acupressure point P6 stimulation versus those that received both the transdermal scopolamine patch and acupressure point P6 stimulation.
Following IRB approval and informed consent, 137 patients were randomly allocated into: Group I (n=44) - scopolamine patch group, Group II (n=53) - P6 stimulation group, and Group III (n=40) - scopolamine patch + P6 stimulation group. Evidence of N&V was collected intraoperatively. Satisfaction scales for nausea and vomiting treatment and overall satisfaction were recorded (0 = no satisfaction; 10 = best satisfaction); score of 9 or 10 was considered “extremely satisfied.” IBM SPSS Statistics V22.0 was used for Chi-squared test, Fisher’s exact test, and ANOVA analysis of our data.
Baseline characteristics were similar between the three study groups. There was no significant difference between the intraoperative N&V experienced in all three groups. Parturients in the groups with the P6 stimulation were significantly more satisfied with overall anesthesia care than those without P6 stimulation (Group I – 84.1%, Group II – 98.1%, Group III – 95%, p = 0.02). There was no significant difference in the number of parturients who were extremely satisfied with the antiemetic treatment (Group I – 70.5%, Group II – 83%, Group III – 85%, P – value = 0.2).
Parturients were more satisfied with the overall anesthetic care when they received the P6 stimulation than when they receive just the scopolamine patch. Parturients in all three groups experienced low incidence of N&V with high satisfaction. All three of our treatment groups experienced less nausea than what we found in the control group of our previous clinical trial (73.3%). Our data suggests that transdermal scopolamine patch application and P6 stimulation are simple, non-invasive, effective alternative antiemetic treatments that could be of great interest to patients and obstetric anesthesiologists who prefer less invasive care with fewer side effects for cesarean section performed under regional anesthesia.
1. Lussos SA,et al. Reg Anesth. 1992;17(3):126-130.
2. Kotelko DM, et al. Anesthesiology. 1989;71(5):675-678.