Abstract
Objectives
Pain management in emergency department (ED) patients is variable and often inadequate.
This study sought to (1) describe the variability in intravenous opioid dosing and
(2) compare the outcomes that result from the most commonly prescribed opioid doses.
Methods
This prospective cohort study enrolled emergency patients who were prescribed intravenous
morphine or hydromorphone as their initial analgesic. Subjects were interviewed at
the time of opioid administration and 1 to 2 hours after opioid administration. Outcomes
included the numeric pain score change (using a 0-10 scale), the proportion achieving
a 50% pain score reduction, and the proportion developing side effects. Logistic regression
was used to assess the effects of demographic, clinical, and treatment variables on
outcomes.
Results
Six hundred ninety-one patients were analyzed. Initial equianalgesic dosages varied
by a factor of 27 (from 1 mg morphine to 4 mg hydromorphone). Opioid dose titration
occurred in only 21% of patients.
Outcomes were similar across the range of opioid dosages before and after adjusting
for potentially confounding variables. Among patients not taking opioids at home who
received a total of 4 mg of morphine or less. 48% achieved at least a 50% pain score
reduction and 60% did not want additional analgesics.
Conclusions
We found marked opioid dosing variability and infrequent opioid dose titration. A
substantial number of ED patients with severe pain responded well to relatively low
opioid dosages. Improved ability to predict opioid dose requirements and strategies
that increase the use of opioid dose titration in ED patients are needed.
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Article Info
Publication History
Published online: March 26, 2010
Accepted:
June 24,
2009
Received in revised form:
June 23,
2009
Received:
May 28,
2009
Footnotes
Results from this study have been presented in abstract form at the annual meetings of the American Academy of Pain Medicine (New Orleans, La, February 2007) and the Society of Academic Emergency Medicine (Chicago, Ill, May 2007).
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
