title: Does midazolam enhance pain control in prehospital management of traumatic severe pain?
abstract: OBJECTIVE
  Midazolam comedication with morphine is a routine practice in pre and postoperative patients but has not been evaluated in prehospital setting. We aimed to evaluate the comedication effect of midazolam in the prehospital traumatic adults.
  
  
  METHODS
  A prehospital prospective randomized double-blind placebo-controlled trial of intravenous morphine 0.10 mg/kg and midazolam 0.04 mg/kg vs morphine 0.10 mg/kg and placebo. Pain assessment was done using a validated numeric rating scale (NRS). The primary end point was to achieve an efficient analgesic effect (NRS≤3) 20 minutes after the baseline. The secondary end points were treatment safety, total morphine dose required until obtaining NRS≤3, and efficient analgesic effect 30 minutes after the baseline.
  
  
  RESULTS
  Ninety-one patients were randomized into midazolam (n=41) and placebo (n=50) groups. No significant difference in proportion of patients with a pain score≤3 was observed between midazolam (43.6%) and placebo (45.7%) after 20 minutes (P=.849). Secondary end points were similar in regard with proportion of patients with a pain score≤3 at T30, the side effects and adverse events except for drowsiness in midazolam vs placebo, 43.6% vs 6.5% (P<.001). No significant difference in total morphine dose was observed, that is, midazolam (14.09 mg±6.64) vs placebo (15.53 mg±6.27) (P=.315).
  
  
  CONCLUSIONS
  According to our study, midazolam does not enhance pain control as an adjunctive to morphine regimen in the management of trauma-induced pain in prehospital setting. However, such midazolam use seems to be associated with an increase in drowsiness.
authors.affiliation: Quimper Hospital CHIC, Emergency Department SMUR, Quimper 29000.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Auffret
authors.affiliation: INSERM CIC 0502, Brest Medical University Hospital, Brest 29200.
authors.forename: Maelenn
authors.initials: M
authors.lastname: Gouillou
authors.affiliation: Quimper Hospital CHIC, Emergency Department SMUR, Quimper 29000.
authors.forename: Gwenael Rolland
authors.initials: GR
authors.lastname: Jacob
authors.affiliation: Brest Medical University Hospital, Brest 29200.
authors.forename: Morgane
authors.initials: M
authors.lastname: Robin
authors.affiliation: Nantes Medical University Hospital, SAMU, Nantes 44000.
authors.forename: Joël
authors.initials: J
authors.lastname: Jenvrin
authors.affiliation: Brest Medical University Hospital, Brest 29200.
authors.forename: Florence
authors.initials: F
authors.lastname: Soufflet
authors.affiliation: INSERM CIC 0502, Brest Medical University Hospital, Brest 29200. Electronic address: zarrin.alavi@chu-brest.fr.
authors.forename: Zarrin
authors.initials: Z
authors.lastname: Alavi
mesh_terms: D059787:Acute Pain / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam