The pathophysiology, incidence, impact, and treatment of opioid‐induced nausea and vomiting

Abstract

Purpose Opioid medications are integral in managing acute moderate‐to‐severe pain. Opioid analgesics bind to μ (mu), κ (kappa), or δ (delta) opioid receptors in the brain, spinal cord, and digestive tract. However, opioids cause adverse effects that may interfere with their therapeutic use. Some adverse effects wane over time, but patients using opioids for acute pain struggle with opioid‐induced nausea and vomiting (OINV) the entire time they take the opioid. This article discusses the underlying mechanisms, clinical implications, and treatment strategies of OINV. Data sources Systematic search and review of Medline, PubMed, and Google Scholar for articles relating to OINV. In addition, package inserts provided pharmacologic data and dose recommendations as needed. Conclusions Research suggests approximately 40% of patients may experience nausea and 15%–25% of patients may experience vomiting after opioid administration. Nausea often precedes vomiting, although they can occur separately. Many patients receiving opioids rate the nausea and vomiting as worse than their pain. Nausea and vomiting can lead to complications including electrolyte imbalances, malnutrition, and volume depletion, and can also negatively affect quality of life and postoperative recovery. Implications for practice There are several medications that can be used to treat OINV including serotonin receptor antagonists, dopamine receptor antagonists, and neurokinin‐1 receptor antagonists. Healthcare providers should be proactive about discussing OINV with patients, as this may improve patient outcomes and pain relief.

Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery

“…Therefore, we speculate that the signifcant difference in the incidence of nausea between the two groups may result from the different opioid with IV-PCA. Multiple factors may contribute to opioid induced nausea and vomiting, including activation of opioid receptors in the chemoreceptor trigger zone, vestibular apparatus, and gastrointestinal tract [ 36 ]. Coda BA et al found that there was no significant difference in nausea while compared hydromorphone, morphine and sufentanil IV-PCA in patients with oral mucositis pain following bone marrow transplantation [ 37 ].…”

Novel Associations Between Cyp2B6 Polymorphisms, Perioperative Methadone Metabolism and Clinical Outcomes in Children

“…The predominant adverse effect observed in this cohort was nausea, vomiting, that required antiemetic administration. In fact, about 40% of patients receiving opioids have been shown to experience nausea, and up to 25% may experience vomiting after opioid administration [ 23 , 24 ]. Patients rate nausea, vomiting after surgery worse than surgical pain [ 25 ].…”

Nausea intensity as a reflector of early physical recovery after surgery

“…Feldman, Lee, and Fiore (2015) claim that recovery tools should include aspects of importance for the patient. Nausea is a symptom that patients find unpleasant and also has an impact on the early physical recovery process (Allvin, Ehnfors, Rawal, & Idvall, 2008;Mallick-Searle & Fillman, 2017;Myles & Wengritzky, 2012). Regular monitoring for nausea is recommended to enable early treatment (Franck et al, 2010).…”

“…Programmes for enhanced recovery after surgery (ERAS) have been mentioned as a paradigm shift intended to support healthcare professionals in optimizing postoperative care (Fearon et al, 2005;Lombardi, Berend, & Adams, 2010). The aim is to accelerate physical recovery by minimizing complications such as infections, and reducing length of hospital stay (Fearon et al, 2005).…”