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Three Part Question

In [patients with moderate to severe abdomen pain use of opioid with antiemetic] is [the use of cyclizine is better than metoclopramide] associated with [decreased mortality]?

Clinical Scenario

A 38 year old man presents to the emergency dept with moderate to severe abdomen pain. He requires intravenous morphine for pain and is complaining of feeling nauseous so you decide to give him an intravenous anti-emetic. However, you are concerned that intravenous metoclopramide can increase gastric emptying and contra- indication in intestinal obstruction. You wonder whether there is any evidence to support the fact that metoclopramide is detrimental to patients with moderate to severe abdomen pain.

Search Strategy

Medline 1966- September Week 2 2005 using OVID interface
[{exp abdomen pain/ or abdominal pain.mp or intestinal obstruction.mp. or exp abdominal pain / or exp intestinal perforation / or abdominal pain.mp }AND {metoclopramide.mp. or exp metoclopramide/ or maxolon.mp.} AND {cyclizine.mp. or exp CYCLIZINE/ or valoid.mp. or antihistamine.mp. or exp Histamine H1 Antagonists/ or antihistamine$.mp.}] Limit to humans and English language
Medline 1966- September Week 2 2005 using OVID interface
[{exp abdomen pain/ or abdominal pain.mp or intestinal obstruction.mp. or exp abdominal pain / or exp intestinal perforation / or abdominal pain.mp }AND {metoclopramide.mp. or exp metoclopramide/ or maxolon.mp.} AND {cyclizine.mp. or exp CYCLIZINE/ or valoid.mp. or antihistamine.mp. or exp Histamine H1 Antagonists/ or antihistamine$.mp.}] Limit to humans and English language

Search Outcome

Altogether 152 papers were found by the Medline search. No papers were directly relevant to the three part question

Comment(s)

Intravenous metoclopramide is used regularly as an anti-emetic combination with opioid in moderate to severe abdomen pain. However, many clinicians hold firm views about this matter that cyclizine is better than metoclopramide but there is no published evidence to underpin the views expressed or show that metoclopramide use has detrimental effects in patients with moderate to severe abdomen pain.

Clinical Bottom Line

There appears to be no firm evidences that metoclopramide increases morbidity and mortality in patients with severe abdomen pain when used with opioid analgesia. Consensus guideline or local advice should be followed.