title: Low incidence of nausea and vomiting with intravenous opiate analgesia in the ED.
abstract: Two double-blind, placebo-controlled, prospective randomized trials in the emergency department (ED) setting have examined the use of metoclopramide for the prevention of opiate-induced nausea and vomiting. Both showed a low incidence of vomiting in the control group. This prospective observational study in 205 unselected ED patients with acute pain syndromes measured nausea and vomiting before intravenous opiate administration and 30 and 60 minutes posttreatment. Cumulative incidence of vomiting was 1.5% at 30 minutes and 2.4% at 60 minutes. Corresponding figures for nausea were 4.9% at 30 minutes and 9.3% at 60 minutes, with more than 75% of patients rating their nausea as mild. Prevalence of both nausea and vomiting were higher at baseline than after analgesia. These data support the findings of previous randomized trials that the incidence of nausea and vomiting after intravenous opiate analgesia in the ED is low and argues against routine use of prophylactic antiemetic administration in combination with opiate analgesia.
authors.affiliation: Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.forename: Janet
authors.initials: J
authors.lastname: Talbot-Stern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D009517:New South Wales / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014839:Vomiting / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D008787:Metoclopramide