Pretreatment of Patients Requiring Oral Contrast Abdominal Computed Tomography With Antiemetics: A Randomized Controlled Trial of Efficacy
Received 26 February 2008; received in revised form 22 April 2008 and 27 May 2008; accepted 3 June 2008. published online 21 July 2008.
Study objective
Ingestion of diatrizoate meglumine before abdominal computed tomography (CT) is time consuming. We hypothesized that pretreatment with metoclopramide or ondansetron would result in faster ingestion of diatrizoate meglumine than placebo.
Methods
The study was a double-blind, randomized controlled trial on adults requiring oral contrast abdominal CT. Patients were randomized to placebo, metoclopramide 10 mg, or ondansetron 4 mg intravenously 15 minutes before ingesting 2 L of diatrizoate meglumine. The primary outcome was time to complete diatrizoate meglumine ingestion. Secondary outcome measures included volume of diatrizoate meglumine ingested, 100-mm visual analog scale for nausea at 15-minute intervals, time to CT, vomiting, and use of rescue antiemetics. The study was powered to detect a 60-minute difference in diatrizoate meglumine ingestion time between saline and medication groups.
Results
One hundred six patients were randomized; placebo (36), metoclopramide (35), and ondansetron (35). Groups were similar in baseline characteristics. Median (interquartile range) times for diatrizoate meglumine ingestion were placebo 109 minutes (82 to 135 minutes); metoclopramide 105 minutes (75 to 135 minutes); and ondansetron 110 minutes (79 to 140 minutes) (P=.67). Vomiting was less frequent with metoclopramide (3%) than placebo (18%) or ondansetron (9%) (P=.11). The visual analog scale for nausea at each point was not significantly different between groups (P=.11). The need for rescue antiemetics was lowest for metoclopramide (3%) compared with placebo (27%) and ondansetron (12%) (P=.02).
Conclusion
Pretreatment with ondansetron or metoclopramide does not reduce oral contrast solution ingestion time.
Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY
Address for correspondence: Gregory Garra, DO, Emergency Medicine, Z=8350, Stony Brook, NY 11784-8350; 631-444-3880, fax 631-444-3919
Supervising editor: Steven M. Green, MD
Author contributions: GG was responsible for study concept and design. GG, DB, JC, and RT acquired the data. GG, AJS, DB, and HCT analyzed and interpreted the data. GG drafted the article. GG, AJS, and HCT were responsible for critical revision of the article for important intellectual content. HCT provided statistical expertise. JC and RT were responsible for administrative, technical, and material support. GG supervised the study. GG takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Publication dates: Available online July 19, 2008.
ABSTRACT