Intravenous morphine titration to treat severe pain in the ED.
OBJECTIVE
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 < or = 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).


CONCLUSIONS
Intravenous morphine titration is a safe and effective option for severe pain when used according to a strict protocol.
Lvovschi
Virginie
V
Department of Emergency Medicine and Surgery, Centre hospitalo-universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, 75013 Paris, France.
Aubrun
Frédéric
F
Bonnet
Pascale
P
Bouchara
Anna
A
Bendahou
Mouhssine
M
Humbert
Béatrice
B
Hausfater
Pierre
P
Riou
Bruno
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D000701:Analgesics, Opioid; D009020:Morphine