Article

Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: Randomised double blind multicentre trial

Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, D-04103 Leipzig, Germany.
BMJ (online) (Impact Factor: 17.45). 08/2006; 333(7563):324. DOI: 10.1136/bmj.38903.419549.80
Source: PubMed

ABSTRACT

To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions.
Four-armed, parallel group, double blind, randomised controlled clinical trial.
Four clinics of a university hospital and four district hospitals in Germany.
3140 patients who received balanced or regional anaesthesia during surgery.
Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions.
Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting (> 12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.
The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions.
Current Controlled Trials ISRCTN31625370 [controlled-trials.com].

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Available from: Jan Wallenborn, Mar 25, 2015
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    • "Treatment for these side effects depends on the receptors involved, and is mainly based on treatment of post-operative opioid-related nausea and vomiting (Tramèr, 2001; Apfel et al., 2004; Büttner et al., 2004; Harris, 2008). Ondansetron and metoclopramide, as seen in Table 1, are effective agents to treat opioid-induced nausea and vomiting (Tramèr, 2001; Apfel et al., 2004; Büttner et al., 2004; Wallenborn et al., 2006). Alternative agents to treat narcotic-associated nausea and vomiting in this setting include droperidol, haloperidol and dexamethasone. "
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    ABSTRACT: Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of-Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of 'acute', 'abdomen', 'pain', 'emergency' as well as different pain drugs in use, revealed 84 papers. The results of the literature review were incorporated into six sections to describe management of acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdominal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management.
    Full-text · Article · Aug 2014 · European journal of pain (London, England)
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    • "Treatment for these side effects depends on the receptors involved, and is mainly based on treatment of post-operative opioid-related nausea and vomiting (Tramèr, 2001; Apfel et al., 2004; Büttner et al., 2004; Harris, 2008). Ondansetron and metoclopramide, as seen in Table 1, are effective agents to treat opioid-induced nausea and vomiting (Tramèr, 2001; Apfel et al., 2004; Büttner et al., 2004; Wallenborn et al., 2006). Alternative agents to treat narcotic-associated nausea and vomiting in this setting include droperidol, haloperidol and dexamethasone. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Appropriate pain therapy prior to diagnosis in patients with acute abdomi-nal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of-Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of 'acute', 'abdomen', 'pain', 'emergency' as well as different pain drugs in use, revealed 84 papers. The results of the literature review were incorporated into six sections to describe management of acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdomi-nal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management.
    Full-text · Dataset · Jan 2014
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    • "Drugs of these group may be problematic due to the profile of adverse effects, which include not only sedation, but also Parkinson symptoms (tremor, rigor, akinesis) [34] and severe arrhythmias (torsade de pointes), which is why droperidol, one of the oldest and best established anti-emetics and also used in the context of PONV, was withdrawn from the German market, but subsequently relaunched [29]. Several investigations have shown the efficacy of metoclopramide in terms of PONV prophylaxis and therapy when it is used in high doses or in combination with other antiemetic drugs like corticoids [52]. "
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    Full-text · Article · Nov 2013 · Medical science monitor: international medical journal of experimental and clinical research
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