There will be a 3 month pre-intervention phase where participants will be placed on a standard post-operative analgesic regimen consisting of an opioid, a NSAID, and acetaminophen. Patients will record their narcotic and non-opioid analgesic usage patterns in the two weeks following outpatient hand surgery.

During the observational phase, patients will be on scopolamine for a total 6 day course (one patch applied at time of surgery, prescription for one patch), and patients will record their narcotic and non-opioid analgesic usage patterns in the two weeks following outpatient hand surgery. The patients who incorporate scopolamine into their post operative analgesia regimen will be eligible for inclusion in the study.

Post Operative Pain Management

During the observational phase, patients will be given a prescription for an 18 day supply of scopolamine, and patients will record the same data as prior to the intervention.

Scopolamine Patch (Transderm V)

Falk Clinic, 3601 Fifth Ave., Suite 6B

A Novel Usage of Transdermal Scopolamine in Reducing Narcotic Usage in Outpatient Hand Surgery

Determine whether the addition of transdermal scopolamine to a standard analgesic regimen reduces opioid utilization following outpatient hand surgery as reported by patients. The outcomes will be measured through review of post operative pain medication logs, and outcome surveys.

Determine patient compliance with usage of multi-modal analgesic medications and the feasibility of supplementing with an additional agent.The outcomes will be measured through review of post operative pain medication logs, and outcome surveys. Will record number of doses taken of tylenol and ibuprofen

Assess patient and operative factors that contribute to prolonged or greater than expected opioid usage. The outcomes will be measured through review of post operative pain medication logs, and outcome surveys. The patient and operative factors and will be determined from review of the chart and personal interview of the patient. Patients who continue to take pain medications beyond 20 days will be evaluated

Alexander M Spiess, MD

Assistant Professor

Scopolamine (0.3 mg/1 ml, i.m.) Bid; escitalopram （10 mg/d p.o.）QD

Scopolamine (0.3 mg/1 ml, i.m.) QD; placebo (1 ml saline, i.m.) QD; escitalopram （10 mg/d p.o.）QD

Placebo (1 ml saline, i.m.) Bid; escitalopram （10 mg/d p.o.）QD

Major Depressive Disorder

Intramuscular injection with scopolamine (0.3 mg/1ml,QD or Bid) during the first three days;

Scopolamine

Oral escitalopram 10 mg/d throughout the total of 4 weeks treatment

Escitalopram

Intramuscular injection with saline (1ml, QD or Bid) during the first three days;

Saline

Beijing Anding Hospital

Effectiveness Study of Scopolamine Combined With Escitalopram in Patients With MDD

A Double-blind, Controlled, Randomized Study Comparing Escitalopram Combined With Scopolamine or Escitalopram in Patients With Major Depressive Disorder

The time from randomization (baseline) to early improvement (at least 20% reduction in HAMD-17 score )

The proportion of subjects with at least 50% decrease in the HAMD-17 at any visit from baseline.Response was defined as ≥50% decrease in the baseline HAMD-17 total scores.

Remission was defined as the HAMD total score ≤7

Change in HAMD-17 scores measured by the difference between baseline HAMD-17 score and HAMD-17 score at endpoint.

Change in MADRS scores measured by the difference between baseline MADRS score and MADRS score at endpoint.

Change in QIDS-SR16 score measured by the difference between baseline QIDS-SR16 score and QIDS-SR16 score at endpoint.

Change in GAD7 score measured by the difference between baseline GAD7 score and GAD7 score at endpoint.

Change in YMRS score measured by the difference between baseline YMRS score and YMRS score at endpoint.

Change in CGI-S score measured by the difference between baseline CGI-S score and CGI-S score at endpoint.

The incidence and nature of overall adverse events; the incidence and nature of drug-related adverse events; assessment of cognitive function change by PDQ-D5

Gang Wang, MD

Director of Beijing Anding Hospital

Capital Medical University

GROUP 1: The patients received intramuscular injection treatment of scopolamine (0.3 mg/ml) at 9 am and 0.9% saline treatment at 3pm. GROUP 2: The patients received intramuscular injection treatment of scopolamine (0.3 mg/ml) at 9 am and 3 PM. GROUP 3: The patients received intramuscular injection treatment of 0.9% saline (1 ml) at 9 am and 3 PM.

Scopolamine 1.5 milligram(mg) patch Propofol infusion remifentanil infusion 250mg erythromycin po for 2 doses Solumedrol 0.625mg IV droperidol 4mg IV Ondansetron Ketorolac 30mg IV ibuprofen 600mg po q6h Fentanyl Hydrocodone/Tylenol po

This arm was managed perioperatively with the protocol.

Intervention Cohort

This arm was a retrospective comparison cohort treated at the same institution, managed per provider preference prior to protocol implementation.

Comparison Cohort

Total

Sex: Female, Male

End of surgery time determined by anesthesia portion of the medical record. PONV to be assessed by review of surgeons' and nurses' notes in the medical record as well as through review of patient diaries. Vomiting constitutes a safety issue and, as such, associated adverse events will be noted.

Patients undergoing maxillary surgery using the antiemetic anesthetic protocol

Post-operative Nausea

Anesthesia start time determined from anesthesia portion of the medical record. Time at which discharge order was placed will serve as time of discharge.

Hospital Length of Stay

To be assessed based on patient diary completed daily for 1 week following discharge to home from the hospital

Patients undergoing maxillary surgery using the antiemetic anesthetic protocol who completed the post-discharge diary.

This arm was a retrospective comparison cohort treated at the same institution, managed per provider preference prior to protocol implementation, who completed the post-discharge diary

Post-discharge Nausea

Post-operative Vomiting

Patients undergoing maxillary surgery using the antiemetic anesthetic protocol who completed the post-discharge diary

Post-discharge Vomiting

Patients undergoing maxillary surgery using antiemetic anesthesia protocol

Overall Study

Dr. Jay Anderson, PI

Patients undergoing maxillary surgery using the antiemetic anesthesia protocol

Nausea Persistent

Intervention group consisted of patients undergoing maxillary osteotomy who received an antiemetic protocol designed to provide multimodal antiemetic therapy which have been shown to help prevent and/or treat postoperative nausea, combined with the elimination of anesthetic factors that may contribute to postoperative nausea and vomiting.

Antiemetic anesthesia protocol

UNC-Chapel Hill

Study of Anesthesia Techniques to Reduce Nausea and Vomiting After Jaw Corrective Surgery

A Prospective Evaluation of an Anesthesia Protocol to Reduce Post-operative and Post-discharge Nausea and Vomiting in a High Risk Orthognathic Surgery Population

attention deficit hyperactivity disorder/히오스신

A Novel Usage of Transdermal Scopolamine in Reducing Narcotic Usage in Outpatient Hand Surgery

Effectiveness Study of Scopolamine Combined With Escitalopram in Patients With MDD

Study of Anesthesia Techniques to Reduce Nausea and Vomiting After Jaw Corrective Surgery

Explore the Nature Factors Relevant to Learning-Pioneering Natural Factors That Influences Science Learning II

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