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Umair Shafqat
Sareer Haider
Syed Azaz Ali Shah
Muhammad Umair Tariq
Ihtisham Ul Haque
Noor Ul Imbisat
Faizan Banaras


Prophylactic antiemetics, opiates, trauma, postoperative nausea and vomiting, randomized controlled trial, patient outcomes


Background: The use of prophylactic antiemetics alongside opiates in trauma management has been a subject of debate, with conflicting evidence regarding its efficacy. In light of this, a randomized controlled trial was conducted at Queen Elizabeth Hospital Birmingham from January 2023 to August 2023.

Aim: This study aimed to investigate whether the adjunctive use of prophylactic antiemetics with opiates in trauma patients is a myth or a reality in terms of reducing postoperative nausea and vomiting (PONV) incidence and improving patient outcomes.

Methods: A total of 200 trauma patients were randomly assigned to either the experimental group receiving prophylactic antiemetics alongside opiates or the control group receiving opiates alone. The incidence of PONV, pain scores, length of hospital stay, and adverse events were assessed and compared between the two groups.

Results: Analysis revealed a significant reduction in the incidence of PONV in the experimental group compared to the control group (p < 0.05). Additionally, patients in the experimental group reported lower pain scores and shorter hospital stays. No significant increase in adverse events was observed in the experimental group.

Conclusion: The findings of this study suggest that the adjunctive use of prophylactic antiemetics with opiates in trauma patients is indeed beneficial, as it reduces the incidence of PONV, alleviates pain, and potentially facilitates earlier discharge without notable adverse effects. Thus, it challenges the notion that this practice is merely a myth and underscores its potential as a valuable adjunct in trauma management.

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1. Kornilov E, Baker Erdman H, Kahana E, Fireman S, Zarchi O, Israelashvili M, Reiner J, Glik A, Weiss P, Paz R, Bergman H. Deep brain stimulation surgery under ketamine induced conscious sedation: a double blind randomized controlled trial. medRxiv. 2023:2023-08.
2. Duan C, Hao Z, Yang J, Song F, Fan X, Li R. Efficacy and safety of ultrasound-guided serratus anterior plane block with different doses of dexmedetomidine for patients undergoing modified radical mastectomy: A randomized controlled trial.
3. Hyland SJ, Wetshtein AM, Grable SJ, Jackson MP. Acute pain management pearls: a focused review for the hospital clinician. InHealthcare 2022 Dec 22 (Vol. 11, No. 1, p. 34). MDPI.
4. Chen J, Wang CY, Zhong JW, Cai YH, Zhang J, Wang F, Zhang M, Gu H, Ma HY, Wang Z, Wu J. Comparison of Postoperative Analgesia and Side Effects in Pediatric Laparoscopic Surgery with Morphine and Nalbuphine. iScience. 2024 Feb 20.
5. Feng Y, Chang P, Liu J, Zhang WS. Effects and mechanisms of perioperative medications on the hypothalamic pituitary adrenal response to surgical injury: A narrative review. Journal of Clinical Anesthesia. 2024 Jun 1;94:111367.
6. Petersen AS, Lund N, Jensen RH, Barloese M. Real-life treatment of cluster headache in a tertiary headache center–results from the Danish Cluster Headache Survey. Cephalalgia. 2021 Apr;41(5):525-34.
7. Sahu S, Verma N, Jain D. Perioperative and Anesthetic Considerations in Maxillofacial Trauma. Maxillofacial Trauma: A Clinical Guide. 2021:101-22.
8. Buchmayer F, Kasper S. Overcoming the myths of esketamine administration: different and not difficult. Frontiers in Psychiatry. 2023 Nov 23;14:1279657.
9. Vélez-Jiménez MK, Chiquete-Anaya E, Orta DS, Villarreal-Careaga J, Amaya-Sánchez LE, Collado-Ortiz MÁ, Diaz-García ML, Gudiño-Castelazo M, Hernández-Aguilar J, Juárez-Jiménez H, León-Jiménez C. Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico. Cephalalgia Reports. 2021 Jul 19;4:25158163211033969.
10. Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare 2021, 9, 333. Perioperative Care. 2021:5.
11. Saxena A, Nekhendzy V. Anesthetic considerations for functional endoscopic sinus surgery: a narrative review. Journal of Head and Neck Anesthesia. 2020 May 1;4(2):e25.
12. Khatib S, Razvi SS, Shaikh MM, Khan MM. Acute Post-operative Pain Management. Updates in Anesthesia-The Operating Room and Beyond. 2023 Jan 29.
13. Donisi V, Mazzi MA, Gandolfi M, Deledda G, Marchioretto F, Battista S, Poli S, Giansante M, Geccherle E, Perlini C, Smania N. Exploring emotional distress, psychological traits and attitudes in patients with chronic migraine undergoing OnabotulinumtoxinA prophylaxis versus withdrawal treatment. Toxins. 2020 Sep 8;12(9):577.
14. Kovacheva V, Schreiner J, Albrecht MA. Obstetric Anesthesia. InAnesthesia Student Survival Guide: A Case-Based Approach 2022 Oct 20 (pp. 427-453). Cham: Springer International Publishing.
15. Bairwa M, Kant R. Tetanus: An update on Management. Official Publication of the Indian Medical Association. 2020 Dec;118(12):18.
16. Brown-Hellsten M. Symptom assessment and management across the cancer trajectory. Ethical issues in pediatric hematology/oncology. 2020:165-201.
17. Argyriou AA, Mantovani E, Mitsikostas DD, Vikelis M, Tamburin S. A systematic review with expert opinion on the role of gepants for the preventive and abortive treatment of migraine. Expert Review of Neurotherapeutics. 2022 Jun 3;22(6):469-88.
18. Hyland SJ, Wetshtein AM, Grable SJ, Jackson MP. Acute Pain Management Pearls: A Focused Review for the Hospital Clinician. Healthcare 2023, 11, 34.
19. Chu C, Baumgartner K, Bositis CM. TRANSMISSION PREVENTION STRATEGIES. Fundamentals of HIV Medicine 2023: CME Edition. 2023 Oct 24:31.
20. Sundar KS, Mohiuddin A, Erande S. Deciphering Optimal Management Options for Headache. Arch Neurol Neurol Disord. 2023;6(1):142.
21. Khan SM, Elobied MA, Fernando R. Post Dural Puncture Headache in Obstetric Patients: A Review Article. Annals of the Romanian Society for Cell Biology. 2021 Apr 11:3212-26.
22. Ozdemir H, Arslantas R. Headache after neuraxial blocks: A focus on combined spinal-epidural anesthesia. InTreatments, Mechanisms, and Adverse Reactions of Anesthetics and Analgesics 2022 Jan 1 (pp. 281-290). Academic Press.
23. Azoury SC, Matros E. Top 25 Medications the Plastic and Reconstructive Surgery Trainee Should Know for an Emergency Medicine Department Consult. Plastic and Reconstructive Surgery. 2024 Feb 1;153(2):474e-89e.
24. Khan J, Al Asoom LI, Al Sunni A, Rafique N, Latif R, Al Saif S, Almandil NB, Almohazey D, AbdulAzeez S, Borgio JF. Genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. Biomedicine & Pharmacotherapy. 2021 Jul 1;139:111557.
25. Black A, Laubert D, Cockrum C. Propofol-Ketamine Versus Propofol-Remifentanil in Office-Based Facial Plastic Surgery: Comparison of Postoperative Pain (Doctoral dissertation, Webster University).

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