Inhaled isopropyl alcohol from a medication pad relieves nausea in emergency department patients, at least in the short term, according to a small randomized controlled trial published online December 8 in the Annals of Emergency Medicine.
"Although our results provide data only during a limited 10-minute period, our potential identification of an agent outperforming placebo may provide a useful tool for treating nausea in this undifferentiated patient population," write Kenneth Lee Beadle, DSc, from the San Antonio Uniformed Services Health Education Consortium in Texas, and colleagues.
"Antiemetics have been demonstrated by randomized trials to outperform placebo in the treatment of postoperative and postchemotherapy nausea and vomiting," the authors write. "Yet commonly prescribed antiemetics including ondansetron, metoclopramide, and promethazine have not outperformed placebo in randomized trials of patients with nausea who present to the [emergency department]."
The study involved 80 patients, aged 18 to 65 years, at San Antonio Military Medical Center. The patients all complained of nausea or vomiting, rated as at least a 3 on a scale of 0 to 10 in severity. The researchers randomly assigned the patients to nasally inhale fumes from a medication pad with either isopropyl alcohol or normal sterile saline (placebo). Patients inhaled for no more than 60 seconds with the pads placed within 2.5 cm of their noses at the start of their visit, and then inhaled again 2 and 4 minutes later.
Median baseline nausea was 6 in both groups 10 minutes after inhalation; the 37 patients who received the alcohol reported a median score of 3 for nausea compared with a median score of 6 among the 43 patients in the placebo group. Similarly, the median score for patient satisfaction was 4 of 5 in the group receiving alcohol compared with 2 of 5 in the placebo group.
"The mechanism of isopropyl alcohol's antinausea effect is unclear," the authors write. "This effect may be related to olfactory distraction," based on previous research finding similar alleviation of nausea from inhaling scented oils. "Another posited explanation relates to the controlled breathing because of the inhalation instructions rather than a pharmacologic effect."
The authors report no adverse events but acknowledged several limitations of the study, including potential selection bias of participants, the subjectivity of outcomes assessment, the possibility that total blinding did not occur because of the scent of the medication pads, and the short duration of observation.
"Multiple studies have noted rapid onset of nausea alleviation with isopropyl alcohol but high incidence of symptom recurrence, particularly over periods beyond 6 hours postintervention," the authors write.
"Future research is necessary to better inform the duration of effect and performance in comparison with traditional antiemetics."
Longer studies in the emergency department could help determine how long the effect lasts and compare alcohol inhalation with other therapies such as ondansetron. "Nevertheless," the authors write, "emergency medicine providers should consider incorporation of this agent into their clinical practice."
The authors have disclosed no relevant financial relationships.
Ann Emerg Med. Published online December 8, 2015. Abstract
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