title: Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients.
abstract: This study was carried out to evaluate the compliance with a morphine protocol and its effects on pain relief in pre-hospital care. In this prospective study, pain intensity was evaluated by the Visual Analog Scale (VAS) from the beginning and every 5 min until hospital arrival (Tend). Group 1: No major deviation from the protocol (intravenous morphine as a first bolus of 0.05 mg/kg followed by repeated boluses every 5 min until VAS < or = 30 mm). Group 2: Major deviation from the protocol. There were 216 patients included. The mean dose of morphine was 9.0 +/- 5.7 mg. The morphine protocol was respected in 123 patients (57%). The mean VAS score was significantly better at Tend in Group 1 vs. Group 2 (27.8 +/- 21.1 mm vs. 37.8 +/- 22.1 mm, respectively), the degree of pain relief was significantly better (73% vs. 53%, respectively) and the initiation time for pain relief was significantly shorter in Group 1 vs. Group 2 (10 min [5-15] vs. 15 min [10-26], respectively). Satisfaction was significantly better in patients expressing pain relief than in unrelieved patients (94% vs. 61%, respectively). Out-of-hospital pain management using morphine depends on careful attention to dosage and the time interval between re-injections. Emergency teams may employ these data to improve the quality of pain relief in the field.
authors.affiliation: Department of Anesthesiology, Intensive Care and Prehospital Emergency Care, Beaujon Université Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Ricard-Hibon
authors.forename: Vanessa
authors.initials: V
authors.lastname: Belpomme
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chollet
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Devaud
authors.forename: Frederic
authors.initials: F
authors.lastname: Adnet
authors.forename: Stephen
authors.initials: S
authors.lastname: Borron
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000145:classification / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine