The effect of intravenous metoclopramide on pain, nausea, discomfort, and ease of insertion of nasogastric tube in emergency department: a double-blind randomized clinical trial

Abstract

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency
departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.
Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T₀), immediately (T₁), 30 min after (T₂), and 1hr after the NGT placement (T₃). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass.
Results: None of the patients had pain, nausea, and discomfort in T₀. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T₁ (37.7 vs 55.0), T₂ (26.2 vs 41.7), and T₃ (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the intervention
group compared with the placebo group in T₁ (32.7 vs 43.2), T₂ (19.5 vs 31.2), and T₃ (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantly
among patients in the intervention group compared with the placebo group in T₁ (39.5 vs 54.0), T₂ (28.7 vs 40.2), and T₃ (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001).
Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.