Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes?

PLoS One. 2017 Mar 14;12(3):e0173925. doi: 10.1371/journal.pone.0173925. eCollection 2017.

Abstract

Although opioid-induced nausea and vomiting (OINV) is common and debilitating, its mechanism is still unclear. Recently, we suggested that opioids affect semicircular canal function and that this leads to a mismatch between canal input and other sensory information during head motion, which triggers OINV. Here, we assess if visual input is relevant for this mismatch. In a randomized-controlled crossover study 14 healthy men (26.9±3.4 years, mean±SD) were tested twice, once blindfolded and once with eyes open, with at least one-day washout. The opioid remifentanil was administered intravenously (0.15 μg/kg/min) for 60 minutes. After a thirty-minutes resting period, subjects' head and trunk were passively moved. Nausea was rated before remifentanil start (T0), before the movement intervention (T30) and after 60 minutes (T60) of administration. At rest (T0, T30), median nausea ratings were zero whether subjects were blindfolded or not. Movement triggered nausea independently of visual input (nausea rating 1.5/3.0 (median/interquartile range) in the blindfolded, 2.5/6 in the eyes-open condition, χ2(1) = 1.3, p = 0.25). As movement exacerbates OINV independently of visual input, a clash between visual and semicircular canal information is not the relevant trigger for OINV. To prevent OINV, emphasis should be put on head-rest, eye-closure is less important.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Cross-Over Studies
  • Eye
  • Humans
  • Nausea / chemically induced
  • Nausea / prevention & control*
  • Rest*
  • Vomiting / chemically induced
  • Vomiting / prevention & control*

Substances

  • Analgesics, Opioid

Grants and funding

This work was supported by the German Federal Ministry of Education and Research (Grants 01 EO 0901 and 01 EO 0914). The funder "Schön Klinik Bad Aibling" provided support in the form of salaries for author KJ, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of this author are articulated in the ‘author contributions’ section.