Although metoclopramide appears to be commonly used to prevent
nausea/vomiting following the administration of morphine, a study by
Talbot-Stern appears to find that the use of prophylactic metoclopramide is
unnecessary. I would be interested in any comments people have on this
issue. The Ambulance Service of NSW decided some years ago that
metoclopramide would no longer be routinely given with morphine.
Unfortunately I know of no study that was done within this service to
identify the actual incidence of nausea or vomiting following the withdrawal
of metoclopramide. The abstract from the Talbot-Stern study is reproduced
below:
Talbot-Stern J. Paoloni R. Prophylactic metoclopramide is unnecessary with
intravenous analgesia in the ED. American Journal of Emergency Medicine.
18(6):653-7, 2000 Oct
Antiemetics are commonly prescribed as prophylaxis for nausea and vomiting
when opiate analgesics are prescribed in the emergency department. This
prospective, randomized, double-blind, placebo-controlled trial assessed the
incidence of nausea and vomiting after morphine and pethidine (meperidine)
analgesia, and the effect of metoclopramide on this incidence. Intravenous
morphine or pethidine analgesia was administered with metoclopramide or
placebo to 122 opiate-naive patients with acute severe pain. Seven patients
(5.7%) experienced nausea, three in the metoclopramide group and four in the
placebo group. One patient (0.8%) had vomiting. The frequency of other side
effects was higher in the metoclopramide group (7.9% versus 3.4%). None of
these differences reached statistical significance. The low incidence of
nausea and vomiting after opiate analgesia, and higher incidence of side
effects with metoclopramide, are consistent with controlled data in the
literature. Prophylactic metoclopramide should not be used routinely in ED
patients receiving parenteral morphine or pethidine analgesia.
Regards, Bill Lord
Charles Sturt University
Australia
|