Intravenous morphine titration to treat severe pain in the ED☆☆☆★
Abstract
Purpose
We assessed the safety of intravenous morphine titration in the emergency setting.
Methods
A total of 621 consecutive adult patients admitted in the ED with acute severe pain (visual analogue scale pain score >70) were included. Intravenous morphine titration was administered as a bolus of 2 (body weight ≤60 kg) or 3 mg (body weight >60 kg) with 5-minute interval between each bolus. Pain relief was defined as a visual analogue pain score of 30 or lower.
Results
The dose of morphine administered was 0.16 ± 0.10 mg/kg and the median number of boluses was 3. Pain relief was obtained in 512 (82%) patients. Morphine-induced adverse events occurred in 67 patients (11%) without severe adverse event. Titration was interrupted before pain relief had been obtained in 107 (17%) patients. In the remaining 514 patients, pain relief was obtained in 507 (99%) patients. Two variables were significantly associated with no pain relief: major protocol deviation (odds ratio, 17.3; 95% confidence interval, 10.0-30.1) and morphine-induced adverse effect (odds ratio, 13.0; 95% confidence interval, 6.7-25.3).
Conclusion
Intravenous morphine titration is a safe and effective option for severe pain when used according to a strict protocol.
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☆ Authors' contributions: Virginie Lvovschi took part in data acquisition and verification, interpretation of the results, emergency physician training, and drafting of the manuscript. Frédéric Aubrun took part in the study conception and interpretation of the results. Pascale Bonnet and Mouhssine Bendahou took part in data acquisition and emergency physician training. Anna Bouchara took part in data acquisition and verification, and interpretation of the results. Béatrice Humbert took part in nurse training and administrative support. Pierre Hausfater took part in interpretation of the results and revision of the manuscript. Bruno Riou took part in study conception, statistical analysis, interpretation of the results, and drafting of the manuscript. All authors contributed to the final version of the manuscript.
☆☆ Conflict of interest: We declare that we have no conflict of interest related to this work. The funding source had no role in the study conception and manuscript writing.
★ Sources of support: The study was supported by a research grant from Fondation des Hôpitaux de France. Other support was provided solely by institutional sources.
PII: S0735-6757(07)00703-6
doi:10.1016/j.ajem.2007.10.025
© 2008 Elsevier Inc. All rights reserved.
