Alcohol Pad Aromatherapy vs. Ondansetron

May 8, 2018

Written by Clay Smith

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Sniffing an isopropyl alcohol pad was more effective at reducing nausea than oral ondansetron at 30 minutes.

Why does this matter?
Fast relief from nausea is difficult but important for patient comfort.  Sometimes this is critically important, such as those with increased ICP or possible open globe.  A study about 2 years ago found that inhaled isopropyl was helpful.  So can sniffing an alcohol pad really help?

No, college students, drinking more alcohol will not help.
This was a RCT with 122 patients randomized to sniff an isopropyl alcohol pad + oral ondansetron; sniff an alcohol pad + oral placebo; or sniff a saline pad + oral ondansetron.  Those who sniffed the alcohol pad had a reduction of about 30mm on a visual analog scale (VAS). Those with only oral ondansetron had a 9mm nausea reduction at 30 minutes post-intervention.  More patients who did not sniff an alcohol pad needed rescue ondansetron.  Although the primary outcome was VAS at 30 minutes, they recorded it at ongoing time points.  There was suggestion of a sustained effect from isopropyl alone out to 3 hours, though the sample size was very small at the later time assessments.

Source
Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial.  Ann Emerg Med. 2018 Feb 17. pii: S0196-0644(18)30029-5. doi: 10.1016/j.annemergmed.2018.01.016. [Epub ahead of print]

Another Spoonful

• Journal Watch called this practice changing (subscription required), which is saying something.
• EM Lit of Note also reviewed it favorably.

Peer reviewed by Thomas Davis