title: Comparison of morphine-midazolam versus morphine injection for pain relief in patients with limb fractures - a clinical trial.
abstract: BACKGROUND
  Pain relief, using opiates as a primary choice, is an important part of treating limb fractures. Yet, in order to reduce opiate consumption, other combinations have been introduced. This study aimed to compare pain reduction by a combination of morphine-midazolam with morphine injection in patients with limb fractures.
  
  
  METHODS
  A randomized double-blind study of patients with upper or lower extremity fractures was conducted. Patients' response to treatment with either morphine-midazolam solution or morphine at 15, 30, 45, 60, 120, and 180 minutes were assessed. The Kaplan-Meier curves and generalized estimating equations were examined to evaluate the success of treatment.
  
  
  RESULTS
  A total of seventy-two patients aged 18-60 (80.6% male; mean age: 35±17.9 years) were included. At 15, 30, 45, and 60 minutes, successful pain control was seen in 8.83 22.2%, 33.3% and 63.9% of the patients in the morphine group, and 11.1%, 27.7%, 44.4% and 63.8% in the midazolam-morphine group. By the third hour, pain-control was achieved in all patients receiving morphine while pain persisted in one patient receiving morphine-midazolam. Log-rank test showed no significant difference between the two groups (p=0.55).
  
  
  CONCLUSIONS
  Our findings revealed that adding midazolam to morphine did not improve its pain-relief profile.
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti Medical University, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Majidi
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti Medical University, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Dinpanah
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti Medical University, Tehran, Iran.
authors.forename: Sahar
authors.initials: S
authors.lastname: Ashoori
authors.affiliation: Department of Emergency Medicine, Jundishapoor University of Medical Sciences, Ahvaz, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Motamed
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti Medical University, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Tabatabaey
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam