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CRITICAL CARE AND TRAUMA

Erythromycin Promotes Gastric Emptying During Acute Pain in Volunteers

Department of Anesthesiology and Intensive Care, and Laboratory of Pathophysiology in Anesthesiology and Intensive Care (EA 18/96), Hôpital de l'Hôtel-Dieu; Department of Pharmacy, Hôpital Debrousse; Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France

Address correspondence to Lionel Bouvet, MD, Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Place d'Arsonval, 69003 Lyon, France. Address e-mail to lionel.bouvet{at}chu-lyon.fr.

In this double-blind cross-over study, we assessed whether erythromycin infusion is effective as a prokinetic drug against gastroparesis from acute pain. The effect of erythromycin on gastric emptying (GE) was measured in seven volunteers subjected to a standardized acute painful stimulus. The GE rate for solids was measured using the octanoic acid breath test. An acetaminophen absorption test measured the GE rate for liquids. Five minutes after ingestion of a ¹³C-labeled meal, the subjects received in randomized order either a test (placebo and erythromycin groups) or a control (control group) stimulus consisting of repeated 1-min immersion of a hand into 4°C (test) or 37°C (control) water, with 15 s for recovery between immersions, for a total of 20 min. While the stimulus was applied, 250 mL saline (control and placebo groups) or 250 mg erythromycin (erythromycin group) was infused. Pain and stress were evaluated using visual analog scales, and standard hemodynamic values were recorded throughout the study. Our results show that acute stress decreased GE for solids, which was significantly accelerated in the erythromycin group in comparison with the placebo group. GE for liquids was similar in the three groups. We conclude that erythromycin is effective as a prokinetic drug for solids in acute painful situations.