Culver Mark A, Richards Emily C, Jarrell Daniel H, Edwards Christopher J
Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona.
Department of Pharmacy, Banner University Medical Center Tucson, Tucson, Arizona.
J Emerg Med. 2017 Nov;53(5):629-634. doi: 10.1016/j.jemermed.2017.06.040. Epub 2017 Oct 5.
The current literature suggests that the prophylactic use of antiemetics is ineffective at preventing nausea or vomiting caused by opioids in the emergency department (ED). While there is no data evaluating ondansetron's efficacy for preventing opioid-induced nausea and vomiting, this practice remains common despite a lack of supporting evidence.
This study aimed to identify if prophylactic ondansetron administered with intravenous (IV) opioids prevents opioid-induced nausea or vomiting.
This prospective observational study was conducted in the ED at two academic medical institutions. Patients were eligible for enrollment if they were prescribed an IV opioid with or without IV ondansetron and absence of baseline nausea. Patients' level of nausea was evaluated at baseline, 5 min, and 30 min after an IV opioid was administered and then observed for 2 hours.
One hundred thirty-three patients were enrolled, with 90% of patients presenting with a chief complaint of pain. Sixty-four (48.1%) patients received an IV opioid alone and 69 (51.9%) patients received both IV ondansetron and an IV opioid. Twenty-three (17.3%) patients developed nausea caused by opioid administration. One (0.75%) patient had an emetic event and 3 (2.3%) patients required rescue antiemetics during their observation period. Rate of nausea was similar between treatment groups 5 min after the opioid was administered (p = 0.153). There was no statistical difference in emesis, rescue medication requirements, or nausea severity between treatment groups.
Our trial found that ondansetron did not appear to be effective at preventing opioid-induced nausea or vomiting. These findings and previous literature suggest prophylactic ondansetron should not be given to ED patients who are receiving IV opioids.
当前文献表明，在急诊科（ED）预防性使用止吐药对预防阿片类药物引起的恶心或呕吐无效。虽然没有数据评估昂丹司琼预防阿片类药物引起的恶心和呕吐的疗效，但尽管缺乏支持证据，这种做法仍然很常见。
本研究旨在确定静脉注射（IV）阿片类药物时预防性使用昂丹司琼是否能预防阿片类药物引起的恶心或呕吐。
这项前瞻性观察性研究在两家学术医疗机构的急诊科进行。如果患者被开具了静脉注射阿片类药物（无论是否同时使用静脉注射昂丹司琼）且无基线恶心症状，则符合入组条件。在静脉注射阿片类药物后基线、5分钟和30分钟时评估患者的恶心程度，然后观察2小时。
共纳入133例患者，90%的患者主要诉求为疼痛。64例（48.1%）患者仅接受静脉注射阿片类药物，69例（51.9%）患者同时接受静脉注射昂丹司琼和静脉注射阿片类药物。23例（17.3%）患者出现了阿片类药物引起的恶心。1例（0.75%）患者发生呕吐事件，3例（2.3%）患者在观察期内需要使用急救止吐药。阿片类药物注射后5分钟时，治疗组之间的恶心发生率相似（p = 0.153）。治疗组之间在呕吐、急救药物需求或恶心严重程度方面无统计学差异。
我们的试验发现，昂丹司琼似乎对预防阿片类药物引起的恶心或呕吐无效。这些发现和以往文献表明，不应给接受静脉注射阿片类药物的急诊科患者预防性使用昂丹司琼。
