Safety assessment of high-dose narcotic analgesia for emergency department procedures.
OBJECTIVE
To evaluate the safety of high-dose IV narcotics in patients requiring analgesia for painful emergency department procedures.


METHODS
Prospective multicenter clinical trial.


METHODS
Five adult urban EDs.


METHODS
All patients received IV meperidine (1.5 to 3.0 mg/kg) titrated to analgesia followed by a painful procedure. Vital signs and alertness scale were recorded at regular intervals, and patients were observed for four hours. Adverse events were monitored and documented. Comparisons between baseline and postanalgesia intervals were made with a repeated measures ANOVA (Dunnett's test).


RESULTS
Although statistically significant changes in vital signs and alertness scale occurred, they were not clinically significant. Opiate reversal with naloxone was not needed in any patient, and no significant respiratory or circulatory compromise occurred.


CONCLUSIONS
This study of 72 patients demonstrates that high-dose narcotic analgesia is appropriate, well tolerated, and safe when used in selected patients before painful procedures in the ED. Narcotic antagonists and resuscitation equipment nonetheless should be available to maximize safety.
Barsan
W G
WG
University of Michigan Medical Center, Ann Arbor.
Tomassoni
A J
AJ
Seger
D
D
Danzl
D F
DF
Ling
L J
LJ
Bartlett
R
R
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D003243:Consciousness / Q000187:drug effects; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008614:Meperidine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D012151:Resuscitation
D009270:Naloxone; D008614:Meperidine