The effect of metoclopramide on gastric emptying in traumatic brain injury.
OBJECTIVE
Gastric paresis in traumatic brain injury (TBI) hinders the effectiveness of enteral support in this patient group. In this study we have investigated the effect of metoclopramide on gastric emptying in TBI patients.


METHODS
In this prospective, randomized, controlled, double-blind study, 19 TBI patients with Glasgow Coma Scale scores of 3-11 were included. In all patients, enteral nutrition was commenced with a nasogastric feeding tube within 48 hours of trauma. Patients were randomized into two groups. In the metoclopramide (M) group, 10 mg metoclopramide was delivered intravenously three times daily for 5 days. In the control (C) group, an equal volume of saline was administered. Besides demographics, gastric emptying according to a paracetamol absorption test at days 0 and 5, time to reach target nutritional requirements, gastric residues, intolerance to feeding, nutritional complications, and clinical outcomes were recorded for each patient.


RESULTS
The gastric residue rates were 2.7+/-7.4 mL and 8.1+/-17.7 mL per 100 patient days for groups C and M respectively (p=0.408). Similarly, feeding intolerance and complication rates did not significantly differ between groups C and M, (respectively p=0.543 and 0.930). Gastric emptying parameters also were similar between the study groups.


CONCLUSIONS
We were unable to document any advantage to using metoclopramide in TBI patients. Simple intragastric enteral feeding with close monitoring of the possible complications seems to be sufficient with acceptable morbidity rates.
Nursal
Tarik Zafer
TZ
Department of General Surgery, Başkent University Adana Teaching and Medical Research Center, General Surgery, Dadaloglu Mah. 39. Sok. No:6, Yuregir, 01250 Adana, Turkey. tznursal@baskent-adn.edu.tr
Erdogan
Bulent
B
Noyan
Turgut
T
Cekinmez
Melih
M
Atalay
Betul
B
Bilgin
Nevzat
N
D000328:Adult; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D018492:Dopamine Antagonists / Q000494:pharmacology*; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000494:pharmacology*; D008875:Middle Aged; D011446:Prospective Studies
D018492:Dopamine Antagonists; D008787:Metoclopramide