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Three Part Question

In [blunt abdominal trauma patients] are [antiemetics efficacious] at [preventing nausea and vomiting following opiate administration]?

Clinical Scenario

A 19-year old male patient presents to the accident and emergency department following an assault in which he sustained direct blows to the abdomen. Following opiate administration, the SHO dealing with the patient wonders which antiemetic to presecribe, if any.

Search Strategy

OVID Medline, EMBASE and CINAHL interfaces
{[exp Multiple Trauma OR exp Child OR exp Middle Aged OR exp Accidents, Traffic OR exp Adult OR exp Appendicitis OR exp Wounds, Nonpenetrating OR exp Tomography, X-Ray Computed OR exp Abdominal Injuries OR exp Adolescent OR exp Pancreas OR exp Hospitalization OR exp Pancreatic Neoplasms OR exp Abdomen OR exp Liver Neoplasms OR exp Abdomen, Acute OR exp Gastrointestinal Diseases] AND [exp Double-Blind Method OR exp Clinical Trials OR exp Cohort Studies] AND [exp Morphine OR exp Morphine Derivatives OR exp Antiemetics] AND [exp Vomiting OR exp "Postoperative Nausea and Vomiting" OR exp Vomiting, Anticipatory]}

Search Outcome

117 from OVID Medline were found, of which none related specifically to the three part question.
119 from EMBASE were found of which none related specifically to the three part question
23 from CINAHL of which none related to the three part question

Comment(s)

Although no papers related to the use of antiemetics in the setting of blunt abdominal trauma, a meta-analysis conducted by Tramer M.R. and Walder B. [1] compared the efficacies of seven different antiemetics (droperidol, ondansetron, hyoscine, tropisetron, metoclopramide, propofol, and promethazine). At 24 hours, the cumulative incidence of nausea and vomiting without antiemetics was approximately 50%. Of the antiemetics reviewed, droperidol was found to be the most effective - with one in three patients receiving relief from nausea and vomiting compared to controls. Evidence for the efficacy of other antiemetics was deemed to be lacking. A latter PRCT compared the efficacy of droperidol, ondansetron and dexamethasone. This study investigated the actions of these drugs in combination with one another, and found that ondansteron combined with either of the other two antiemetics was better than a mixture of droperiol and dexamethasone at preventing post-operative nausea and vomiting (p=0.048) [2]. In none of these studies was antiemetic efficacy related to the setting of blunt abdominal trauma. [1] Tramer MR. Walder B. "Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review" Anesthesia & Analgesia. 88(6):1354-61, 1999 Jun [2] Sanchez-Ledesma MJ. Lopez-Olaondo L. Pueyo FJ. Carrascosa F. Ortega A. "A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting" Anesthesia & Analgesia. 95(6):1590-5, 2002 Dec

Clinical Bottom Line

Not enough evidence exists to support the use of different antiemetics in the setting of blunt abdominal trauma.