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Metoclopramide versus placebo with opioid
  1. W Alsalim, Specialist Registrar,
  2. W C Leung, Lecturer,
  3. John Butler, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

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    Report by W Alsalim, Specialist RegistrarChecked by W C Leung, Lecturer,John Butler, Consultant

    Abstract

    A short cut review was carried out to establish whether metoclopramide reduced nausea and vomiting after the administration of morphine. Altogether 405 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

    Clinical scenario

    A 52 year old man attends the emergency department having been kicked on his right leg by a horse. He is complaining of severe pain in the leg and examination shows deformity. You make the clinical diagnosis of a fracture. You ask for an opioid to relieve his pain; the nurses insist you give metoclopramide as well. You wonder whether there is any evidence to support their assertion that metoclopramide should be given routinely with opioids.

    Three part question

    In [patients treated with opioids] is [metoclopramide better than nothing] in [reducing nausea and vomiting]?

    Search strategy

    Medline 1966-01/04 using the Ovid interface. [(exp vomiting OR exp Nausea OR vomit$.mp OR exp Vomiting, anticipatory OR emesis$.mp OR nausea$.mp) AND (exp metoclopramide OR metoclopramide$.mp) AND (randomised controlled trial.mp OR exp clinical trials OR exp random allocation OR exp randomized controlled trials OR double-blind trial.mp OR exp double-blind method OR exp clinical trials] LIMIT to human AND English.

    Search outcome

    Altogether 405 papers were found of which one is relevant and of sufficient quality for inclusion (see table 3).

    Table 3

    Comment(s)

    While many studies evaluated the effects of metoclopramide postoperatively, only this one evaluated the effects in the emergency department. Because of the low incidence of nausea and vomiting in both groups of this study, it is not possible to make a specific conclusion regarding the prophylactic effect of metoclopramide in reducing opioid associated nausea and vomiting.

    CLINICAL BOTTOM LINE

    The incidence of nausea and vomiting with opioid is very low in these groups of patients. This study did not provide evidence that prophylactic metoclopramide is effective.

    Report by W Alsalim, Specialist RegistrarChecked by W C Leung, Lecturer,John Butler, Consultant

    References

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