title: Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial.
abstract: Tolerance to opioids among opium-dependent patients creates obstacles for proper pain management of these patients in the emergency department (ED). The aim of the present study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine analgesia among opium-dependent patients.
  
  
  
  Opium-dependent adults who were admitted to the ED for new-onset severe pain in the limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating scale [NRS]) were recruited. Participants were randomly assigned into two groups. Group A received morphine 0.05 mg/kg intravenously (IV) and a mixture of midazolam 2.5 mg and haloperidol 2.5 mg (diluted in 5 cc of distilled water, IM); group B received morphine 0.05 mg/kg IV and distilled water 5 cc, IM. Measured outcomes were related to: 1) pain intensity; 2) total doses of morphine; 3) changes in hemodynamic status and level of consciousness of patients. NRS scores (zero to 10) before and one, three and six hours following intervention, as well as total doses of morphine, were recorded.
  
  
  
  We recruited 68 males (78.16%) and 19 females (21.83%). The mean age was 38.28±6.59 years. The pain score in group A declined more rapidly over six hours than that in group B. Moreover, as compared to group B, the amount of morphine use decreased significantly in group A.
  
  
  
  Based on the present data, adding haloperidol plus midazolam to morphine for pain management improved pain scores and lowered morphine consumption among opium-dependent patients.
authors.affiliation: Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Afzalimoghaddam
authors.affiliation: Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Edalatifard
authors.affiliation: Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Nejati
authors.affiliation: Department of Emergency Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Momeni
authors.affiliation: Department of Emergency Medicine, Ziaiian Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Isavi
authors.affiliation: Department of Emergency Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences. Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Karimialavijeh
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D004636:Emergency Service, Hospital; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010865:Pilot Projects; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine; D006220:Haloperidol; D008874:Midazolam
keywords: Analgesia; haloperidol; midazolam; morphine; opium; pain management