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Anesth Analg. 1991 Nov;73(5):553-5.

Metoclopramide: an analgesic adjunct to patient-controlled analgesia.

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Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.


This randomized, double-blind trial evaluated the effect of metoclopramide on the pain and analgesic requirements associated with prostaglandin-induced labor for second-trimester termination of pregnancy. After receiving intrauterine prostaglandin, seven women were given intravenous metoclopramide (10 mg), and eight received saline, concurrent with initiation of patient controlled analgesia (PCA). Group differences were assessed with serial visual analogue scale for pain, interval PCA-morphine consumption, and time to fetal delivery. The metoclopramide group used 54% less PCA morphine (24.1 vs 52.0 mg), had lower visual analogue scale scores, and interval morphine consumption at 2, 4, and 6 h after PCA had been initiated, as well as earlier delivery of the fetus when compared with the control group (P less than 0.05). We conclude that a single dose of metoclopramide reduces the pain and PCA-morphine requirements of patients undergoing prostaglandin-induced labor and may facilitate passage of the fetus. Metoclopramide may have a similar application in treating other types of gynecologic pain.


The peripheral cholinergic, central dopamine antagonist drug metoclopramide was assessed as an anesthesia adjunct in a randomized, double-blind trial in 15 women having 2nd trimester abortion by intraamniotic prostaglandin F2a (Pgf2alpha). 7 of the women received 10 mg metoclopramide iv, and 8 received saline, when patient-controlled-analgesia with iv morphine by pump according to a standard protocol was begun. Pain was assessed every 2 hours by a visual analogue scale (0-10), and by number of doses and total amount of morphine used. The metoclopramide group used 54% less morphine (24.1 vs 52.0 mg), used less morphine in 2-hour intervals for the 1st 6 hours, reported less pain on analog scales, and expelled the fetus significantly earlier than did the saline group (7.2 vs 15.3 hours, p0.05). The lower cumulative morphine dose was influenced by the fact that the fetus was aborted earlier in the test group. There were no significant differences in time of placental delivery, or of hospital discharge, dose of antiemetic (droperidol) or of PGE suppositories given to speed the onset of contractions. metoclopramide may act to coordinate the contractions of the uterus and improve expulsive force. It was effective here only for 6 hours, probably related to its half life of 4-5 hours.

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