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
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 1 hr 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.
metoclopramide, nasogastric tube placement, pain, nausea, discomfort
 Metheny, N. A., Krieger, M. M., Healey, F., et al. (2019). A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart & Lung, vol. 48, no. 3, pp. 226–235.
 Heidarzadi, E., Jalali, R., Hemmatpoor, B., et al. (2020). The comparison of capnography and epigastric auscultation to assess the accuracy of nasogastric tube placement in intensive care unit patients. BMC Gastroenterology, vol. 20, no. 1, pp. 1–6.
 Yang, F. H., Lin, F. Y., and Hwu, Y. J. (2019). The feasibility study of a revised standard care procedure on the capacity of nasogastric tube placement verification among critical care nurses. Journal of Nursing Research, vol. 27, no. 4, p. e31.
 Walsh, S., Gallagher, A., Gallagher, R., et al. (2016). First do no harm: nasogastric tube placement and confirmation. Quarterly Journal of Medicine, vol. 109, no. 3, p. 219.
 Rouhi, A. J., Zeraatchi, A., Rahmani, F., et al. (2020) Effect of oral midazolam in pain relief of patients need nasogastric tube insertion: a clinical trial study. Journal of Research in Pharmacy Practice, vol. 9, no. 2, pp. 112–117.
 Liu, Y., Dong, X., Yang, S., et al. (2017). Metoclopramide for preventing nosocomial pneumonia in patients fed via nasogastric tubes: a systematic review and meta-analysis of randomized controlled trials. Asia Pacific Journal of Clinical Nutrition, vol. 26, no. 5, pp. 820–828.
 Lubawski, J. and Saclarides, T. (2008). Postoperative ileus: strategies for reduction. Therapeutics and Clinical Risk Management, vol. 4, no. 5, p. 913–917.
 Kaneishi, K., Imai, K., Nishimura, K., et al. (2020). Olanzapine versus metoclopramide for treatment of nausea and vomiting in advanced cancer patients with incomplete malignant bowel obstruction. Journal of Palliative Medicine, vol. 23, no. 7, pp. 880–881.
 Rumore, M. M., Lee, S. E., Wang, S., et al. (2011). Metoclopramide-induced cardiac arrest. Clinics and Practice, vol. 1, no. 4, pp. 174–178.
 Ozucelik, D. N., Karaca, M. A., and Sivri, B. (2005). Effectiveness of pre-emptive metoclopramide infusion in alleviating pain, discomfort and nausea associated with nasogastric tube insertion: a randomised, double-blind, placebo-controlled trial. International Journal of Clinical Practice, vol. 59, no. 12, pp. 1422–1427.
 Bong, C. L., Macachor, J. D., and Hwang, N. C. (2004). Insertion of the nasogastric tube made easy. Anesthesiology, vol. 101, no. 1, p. 266.
 Durai, R., Venkatraman, R., and Ng, P. C. (2009). Nasogastric tube insertion technique and confirming position. Nursing Times, vol. 105, no. 16, pp. 12–13.
 Cullen, L., Taylor, D., Taylor, S., et al. (2004). Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Annals of Emergency Medicine, vol. 44, no. 2, pp. 131–137.
 Ozucelik, D., Karaca, M., and Sivri, B. (2005). Effectiveness of pre‐emptive metoclopramide infusion in alleviating pain, discomfort and nausea associated with nasogastric tube insertion: a randomised, double‐blind, placebo‐controlled trial. International Journal of Clinical Practice, vol. 59, no. 12, pp. 1422–1427.
 Ducharme, J. and Matheson, K. (2003). What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine. Journal of Emergency Nursing, vol. 29, no. 5, pp. 427–430.
 Hu, B., Ye, H., Sun, C., et al. (2015). Metoclopramide or domperidone improves post-pyloric placement of spiral nasojejunal tubes in critically ill patients: a prospective, multicenter, open-label, randomized, controlled clinical trial. Critical Care, vol. 19, no. 1, p. 61.
 Heiselman, D. E., Hofer, T., and Vidovich, R. R. (1995). Enteral feeding tube placement success with intravenous metoclopramide administration in ICU patients. Chest, vol. 107, no. 6, pp. 1686–1688.
 Mandal, M. C., Dolai, S., Ghosh, S., et al. (2014). Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: a randomized controlled trial. Indian Journal of Anaesthesia, vol. 58, no. 6, pp. 714–718.
 Pillai, J. B., Vegas, A., and Brister, S. (2005). Thoracic complications of nasogastric tube: review of safe practice. Interactive Cardiovascular and Thoracic Surgery, vol. 4, no. 5, pp. 429–433.
 Hosseininejad, M., Aminiahidashti, H., Pashaei, S. M., et al. (2017). Determinants of prolonged length of stay in the emergency department: a mixed method study from Iran. Emergency, vol. 5, no. 1, pp. 268–273.