Motion sickness: Comparison of metoclopramide and diphenhydramine to placebo


Objectives: This is an evaluation of the efficacy of metoclopramide (MTCP) or diphenhydramine (DPH) to relieve symptoms of motion sickness in patients being transported via ambulance in a mountainous setting.Methods: This is a prospective, randomized, double-blinded, placebo-controlled study of patients transported by ambulance in the Sierra Nevada mountains of Fresno County. Consenting patients who met the inclusion criteria were asked to rate their motion sickness every five minutes using a visual analog scale (VAS) during transport. If motion sickness occurred, they were randomized to receive MTCP (20 mg IV), DPH (50 mg IV), or placebo (normal saline), and remaining symptoms were recorded every five minutes. If signs and symptoms of motion sickness persisted after 15 minutes, a rescue dose of MTCP was offered.Results: Twenty-six patients were enrolled in the study. Twenty-two (84.6%) developed motion sickness and were randomized to MTCP, DPH, or placebo. Eight patients received MTCP, seven received DPH, and seven received placebo. The MTCP group showed a statistically significant decrease in the mean VAS score at 15 minutes compared to the DPH and placebo groups. There was no significant difference in the decrease in VAS score between the placebo and the DPH group. Twelve out of 22 patients requested a rescue dose of MTCP after 15 minutes. At 25 minutes, there was no significant difference in the VAS score between the three groups.Conclusion: During ambulance transport in a mountainous setting, the administration of MTCP is superior to both DPH and placebo in the treatment of motion sickness. Diphenhydramine is not superior to placebo.

1 Read
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this research was to identify personal and environmental factors influencing individual susceptibility to motion sickness during road transport. A questionnaire survey of 3256 coach travellers was conducted. Information on passenger characteristics, travel regularity, activity during travel, use of anti-motion sickness drugs and self-reported motion sickness susceptibility were collected over 56 private hire coach journeys. Details of the travel environment (visibility, temperature and seating) were also recorded. The relationship of these variables with passenger illness and more specific symptoms of motion sickness are examined. Overall, 28.4% of passengers reported feeling ill, 12.8% reported nausea and 1.7% reported vomiting during coach travel. Travel sickness decreased with increasing passenger age and greater travel experience. Females were more likely to report feeling ill during coach travel than males by a ratio of four to three. Poor forward visibility was found to increase sickness. Passenger illness occurrence was approximately three times higher for passengers with no view of the road ahead (mean, 34.6%) compared to passengers who could see the road ahead extremely well (mean, 12.7%). No relationships were found between the occurrence of travel sickness and temperature or time of travel. Differences in the pattern of sickness responses exhibited by coach travellers suggest: (1) habituation through greater travel regularity may occur independently of reductions in travel sickness that occur with age; (2) females are more affected by poor forward visibility than males; and (3) the incidence of travel sickness could be significantly reduced by improving the external visibility afforded to passengers.
    Ergonomics 04/1999; 42(3):444-61. DOI:10.1080/001401399185586 · 1.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors' objectives were: 1) to determine the incidence of motion sickness during ambulance transport on a mountainous route in healthy volunteers, and 2) to determine if droperidol alleviated the signs and symptoms of motion sickness in those volunteers who developed it. This was a prospective, randomized, double-blind, placebo-controlled trial. Subjects were healthy volunteers over age 18 and not currently taking an antiemetic. Participants were transported in the back of an ambulance over a mountainous road. Those who developed motion sickness rated their nausea on a 100-mm visual analog scale (VAS) and were randomized to receive placebo (saline) or 2.5 mg droperidol intravenously. Symptoms were recorded on a VAS every 5 minutes until the end of the transport. Incidence of motion sickness was calculated as a percentage with 95% confidence intervals (CIs). Pretreatment characteristics were compared with chi-square tests, and mean VAS scores were compared using t-tests. Thirty-seven subjects completed the study. Sixteen (43%, 95% CI=27%-59%) developed motion sickness. Fifteen were randomized and completed data collection. Eight received droperidol (mean baseline VAS, 45) and seven received placebo (mean baseline VAS, 40). Droperidol trended toward a greater mean reduction of nausea than placebo at 5 minutes (20 versus 4, p=0.077). The incidence of motion sickness during ambulance transport in a mountainous setting is substantial. There was a strong trend toward a positive treatment effect with droperidol. Further prospective study in an actual patient setting is warranted.
    Prehospital Emergency Care 10/2003; 7(4):474-6. DOI:10.1197/S1090-3127(03)00224-7 · 1.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To test the hypothesis that oxygen administration reduces nausea and vomiting in patients with minor trauma during ambulance transport. This study, conducted from January to April 2000, consisted of 100 patients older than 60 years with minor trauma, who were randomly assigned to breathe air or 100% oxygen at 10 L/min through a facemask during ambulance transport. A paramedic, blinded to treatment, recorded vomiting episodes during transport. Patients, also blinded to treatment, rated their levels of pain, nausea, vomiting, anxiety, and overall satisfaction with their care on 100-mm visual analog scales, with greater values indicating more intense sensation. Results from the 2 groups were compared with chi2 or unpaired 2-tailed t tests and presented as means +/- SDs. Before randomization, patients subsequently assigned to receive oxygen had significantly greater pain and nausea. On arrival at the hospital, oxygen saturation was higher in the 50 patients given oxygen (99% +/- 1 % vs 96% +/- 2%; P<.001) than in the 50 patients who breathed air. Reported pain remained greater in the oxygen group. However, those given oxygen had less nausea (22 +/- 29 vs 54 +/- 38 mm; P<.001) and vomiting (4 vs 19 episodes; P<.001), lower heart rates (86 +/- 12 vs 94 +/- 13 beats/min; P<.001), and higher overall satisfaction scores (54 +/- 33 vs 33 +/- 23 mm; P<.001). Our results indicate that supplemental oxygen during ambulance transport reduced nausea scores by 50% and decreased vomiting 4-fold. Consequently, patients reported greater satisfaction with their care. Thus, we recommend that patients be given supplemental oxygen during ambulance transport.
    Mayo Clinic Proceedings 01/2002; 77(1):35-8. DOI:10.4065/77.1.35 · 6.26 Impact Factor