Evaluation of the need of prophylactic antiemetic with injection Morphine in treating acute musculoskeletal pain in the Indian population.

Objective: The objective of our study was to determine whether injection morphine cause nausea or vomiting in patients attending an Indian Emergency Department with acute musculoskeletal pain. Method: A prospective double-blinded trial was done on 236 patients with musculoskeletal trauma receiving intravenous morphine for analgesia. Children ? 18 years, patients who had been vomiting, raised ICP, or had already received prehospital analgesia or antiemetic, and those unable to give consent were excluded from this study. Along with injection morphine – group one received Ramosetron, group two received Metoclopramide, group three received Promethazine and group four received placebo. Any vomiting or nausea within 4 hours of receiving intravenous morphine was recorded. Result: The four groups were evenly matched for age groups, gender, comorbidities, trauma sites, morphine dose and antiemetic drug volumes. Overall, 12.4% of the patients experienced nausea (9.4% in the group receiving Ramosetron, 18.5% in the group receiving Metoclopramide, 14.3% in the group receiving Promethazine and 6.5% in the group receiving placebo) and 9.9% vomited (7.5% in the group receiving Ramosetron, 14.8% in the group receiving Metoclopramide, 10.2% in the group receiving Promethazine and 6.5% in the group receiving placebo). This difference was however not statistically significant in both the groups (P = 0.27 and P = 0.50 respectively). Conclusion: The incidence of nausea and vomiting in musculoskeletal trauma patients receiving intravenous morphine is low and the routine use of an antiemetic in these patients not needed. Intravenous antiemetic in these patients does not reduce the incidence of nausea & vomiting.