Abstract
Background
It is common practice for emergency physicians to give parenteral opioids for acute
pain, however, some treating physicians have concerns that using parenteral opioids
can lead to nausea and vomiting when used alone. Therefore, antiemetics are often
given prophylactically with opioids for nausea and vomiting in the emergency department
(ED). This systematic review evaluates the use of prophylactic antiemetics with parenteral
opioids for the treatment of acute pain in the ED.
Methods
A 10-year literature search using keywords was performed in PubMed for English-language
human studies. Abstracts were screened to identify high-quality studies, which then
underwent a more rigorous structured review. The recommendations are made based on
the literature review.
Results
Eight articles met criteria for structured review and citation in this article. These
include one review article, two randomized controlled trials, three prospective observational
trials, one retrospective study, and one pre- and post-intervention trial.
Conclusions
Based on the literature review, routine use of prophylactic antiemetics are not indicated
with administration of parenteral opioids for treatment of acute pain in the ED, as
nausea and vomiting are infrequent side effects. The recent literature clearly demonstrates
that there are potential undesirable side effects from the use of antiemetics when
using opioids. However, one subgroup of patients, those with a known history of nausea
and vomiting after opioid use or a history of travel sickness, may benefit from the
use of prophylactic antiemetic when being treated with parenteral opioids.
Keywords
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Article info
Publication history
Published online: March 23, 2020
Accepted:
December 16,
2019
Received:
November 25,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
