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Intravenous morphine titration to treat severe pain in the ED.
Am J Emerg Med. 2008 Jul; 26(6):676-82.AJ

Abstract

PURPOSE

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).

CONCLUSION

Intravenous morphine titration is a safe and effective option for severe pain when used according to a strict protocol.

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Authors+Show Affiliations

Lvovschi 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 F
No affiliation info available
Bonnet P
No affiliation info available
Bouchara A
No affiliation info available
Bendahou M
No affiliation info available
Humbert B
No affiliation info available
Hausfater P
No affiliation info available
Riou B
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAnalgesics, OpioidDose-Response Relationship, DrugEmergency Service, HospitalFemaleHumansInjections, IntravenousMaleMiddle AgedMorphinePainPain MeasurementProspective StudiesStatistics, Nonparametric

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18606320

Clinical Trial Links

First Evaluation of Morphine Hydrochloride by Nebulisation in Healthy Volunteers

Citation

Lvovschi, Virginie, et al. "Intravenous Morphine Titration to Treat Severe Pain in the ED." The American Journal of Emergency Medicine, vol. 26, no. 6, 2008, pp. 676-82.
Lvovschi V, Aubrun F, Bonnet P, et al. Intravenous morphine titration to treat severe pain in the ED. Am J Emerg Med. 2008;26(6):676-82.
Lvovschi, V., Aubrun, F., Bonnet, P., Bouchara, A., Bendahou, M., Humbert, B., Hausfater, P., & Riou, B. (2008). Intravenous morphine titration to treat severe pain in the ED. The American Journal of Emergency Medicine, 26(6), 676-82. https://doi.org/10.1016/j.ajem.2007.10.025
Lvovschi V, et al. Intravenous Morphine Titration to Treat Severe Pain in the ED. Am J Emerg Med. 2008;26(6):676-82. PubMed PMID: 18606320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous morphine titration to treat severe pain in the ED. AU - Lvovschi,Virginie, AU - Aubrun,Frédéric, AU - Bonnet,Pascale, AU - Bouchara,Anna, AU - Bendahou,Mouhssine, AU - Humbert,Béatrice, AU - Hausfater,Pierre, AU - Riou,Bruno, PY - 2007/04/26/received PY - 2007/10/12/revised PY - 2007/10/12/accepted PY - 2008/7/9/pubmed PY - 2008/8/15/medline PY - 2008/7/9/entrez SP - 676 EP - 82 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 26 IS - 6 N2 - PURPOSE: 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). CONCLUSION: Intravenous morphine titration is a safe and effective option for severe pain when used according to a strict protocol. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/18606320/Intravenous_morphine_titration_to_treat_severe_pain_in_the_ED_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(07)00703-6 DB - PRIME DP - Unbound Medicine ER -