USE OF PROPHYLACTIC ONDANSETRON WITH INTRAVENOUS OPIOIDS IN EMERGENCY DEPARTMENT PATIENTS: A PROSPECTIVE OBSERVATIONAL PILOT STUDY
USE OF PROPHYLACTIC ONDANSETRON WITH INTRAVENOUS OPIOIDS IN EMERGENCY DEPARTMENT PATIENTS: A PROSPECTIVE OBSERVATIONAL PILOT STUDY
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DOI：
10.1016/j.jemermed.2017.06.040
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发表时间：
2017-11-01
影响因子：
1.5
通讯作者：
Edwards, Christopher J.
中科院分区：
文献类型：
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作者：
Culver, Mark A.;Richards, Emily C.;Edwards, Christopher J.
背景资料：目前的文献表明，在急诊科（艾德）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有效性，但这种做法仍然很常见，尽管缺乏支持证据。目的：本研究旨在确定静脉（IV）阿片类药物预防性给予昂丹司琼是否可预防阿片类药物引起的恶心或呕吐。方法：这项前瞻性观察性研究在两个学术医疗机构的艾德进行。如果患者接受了静脉注射阿片类药物，伴或不伴静脉注射昂丹司琼，并且没有基线恶心，则有资格入组。在基线、给予IV阿片类药物后5分钟和30分钟评价患者的恶心水平，然后观察2小时。结果：133例患者入组，90%的患者主诉疼痛。64例（48.1%）患者单独接受IV阿片类药物，69例（51.9%）患者同时接受IV昂丹司琼和IV阿片类药物。23例（17.3%）患者发生阿片类药物给药引起的恶心。1例（0.75%）患者发生呕吐事件，3例（2.3%）患者在观察期间需要补救止吐药。阿片类药物给药后5分钟，治疗组之间的恶心发生率相似（p = 0.153）。治疗组之间的呕吐、急救药物需求或恶心严重程度无统计学差异。结论：我们的试验发现昂丹司琼似乎不能有效预防阿片类药物引起的恶心或呕吐。这些发现和以前的文献表明，预防性昂丹司琼不应该给艾德患者谁正在接受静脉阿片类药物。(C)2017爱思唯尔公司All rights reserved.
Background: 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. Objectives: This study aimed to identify if prophylactic ondansetron administered with intravenous (IV) opioids prevents opioid-induced nausea or vomiting. Methods: 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 IVopioid was administered and then observed for 2 hours. Results: 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 IVopioid 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. Conclusion: 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. (C) 2017 Elsevier Inc. All rights reserved.