title: Efficacy and safety of nebulized morphine given at 2 different doses compared to IV titrated morphine in trauma pain.
abstract: BACKGROUND
  Our aim was to compare the efficacy and safety of intravenous (IV) titrated morphine with nebulized morphine given at 2 different doses in severe traumatic pain.
  
  
  METHODS
  In a prospective, randomized, controlled double-blind study, we included 300 patients with severe traumatic pain. They were assigned to 3 groups: Neb10 group received 1 nebulization of 10-mg morphine; Neb20 group received 1 nebulization of 20-mg morphine, repeated every 10 minutes with a maximum of 3 nebulizations; and the IV morphine group received 2-mg IV morphine repeated every 5 minutes until pain relief. Visual analog scale was monitored at baseline, 5, 10, 15, 20, 25, 30, and 60 minutes after the start of drug administration. Treatment success was defined by the percentage of patients in whom visual analog scale decreased greater than or equal to 50% of its baseline value. When this end point was not reached, rescue morphine was administered. Pain resolution time was defined by the elapsed time between the start of the protocol and the reach of treatment success criteria.
  
  
  RESULTS
  Success rate was significantly better at 97% (95% confidence interval [CI], 93-100) for Neb20 group compared to Neb10 group (81% [95% CI, 73-89]) and IV morphine group (79% [95% CI, 67-84]). The lowest resolution time was observed in Neb20 group (20 minutes [95% CI, 18-21]). Side effects were minor and significantly lower in both nebulization groups compared to IV morphine group.
  
  
  CONCLUSIONS
  Nebulized morphine using boluses of 10 mg has similar efficacy and better safety than IV titrated morphine in patients with severe posttraumatic pain. Increasing nebulized boluses to 20 mg increases the effectiveness without increasing side effects.
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.
authors.forename: Mohamed Habib
authors.initials: MH
authors.lastname: Grissa
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Boubaker
authors.affiliation: Emergency Department, Sahloul University Hospital, Sousse, Tunisia.
authors.forename: Asma
authors.initials: A
authors.lastname: Zorgati
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.
authors.forename: Kaouthar
authors.initials: K
authors.lastname: Beltaïef
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Wafa
authors.initials: W
authors.lastname: Zhani
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Mohamed Amine
authors.initials: MA
authors.lastname: Msolli
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Nasri
authors.initials: N
authors.lastname: Bzeouich
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.
authors.forename: Wahid
authors.initials: W
authors.lastname: Bouida
authors.affiliation: Emergency Department, Sahloul University Hospital, Sousse, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.
authors.forename: Riadh
authors.initials: R
authors.lastname: Boukef
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia. Electronic address: semir.nouira@rns.tn.
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
mesh_terms: D000280:Administration, Inhalation; D061605:Administration, Intravenous; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine