Acute pain management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine sulfate in limb traumatized patients: a randomized double-blinded placebo-controlled trial [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2013; 19(5): 398-404 | DOI: 10.5505/tjtes.2013.86383  

Acute pain management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine sulfate in limb traumatized patients: a randomized double-blinded placebo-controlled trial

Davood Farsi1, Mitra Movahedi2, Peyman Hafezimoghadam3, Saeed Abbasi3, Abtin Shahlaee4, Vafa Rahimi Movaghar4
1Hazrat-e-rasool Akram Medical Complex, Tehran University Of Medical Sciences, Tehran, Iran
2Shahid Mohammadi Hospital, Hormozgan University Of Medical Sciences, Bandar Abbas, Iran
3Department Of Emergency Medicine, Tehran University Of Medical Sciences, Tehran, Iran
4Sina Trauma And Surgery Research Center, Sina Hospital, Tehran University Of Medical Sciences, Tehran, Iran

BACKGROUND: We aimed to compare pain relief and safety of two doses of morphine in adult emergency department (ED) patients with acute limb trauma pain.
METHODS: A total of 200 adult ED patients over 20 years of age requiring opioid analgesia were randomly allocated to two groups. Following a first dose of intravenous morphine sulfate at 0.10 mg/kg, a randomized double-blind placebo-controlled trial of intravenous morphine sulfate at 0.05 mg/kg versus the same amount of placebo was performed. Measurement of visual analogue scale pain intensity and assessment of adverse effects were performed at baseline (before morphine at 0.10 mg/kg), 30 minutes from baseline (just before study drug administration), and at 60 minutes from baseline (30 minutes after study drug).
RESULTS: No significant difference was found between groups at 30 minutes from baseline. There was significant reduction in final pain after 1 hour in the 0.15 mg/kg compared to 0.10 mg/kg group (p<0.05). In addition, there was a significant improvement in the mean score of pain in the same group (p<0.05). The percent of pain reduction in the intervention and control group relative to the basic measures was 52.70% and 35.82%, respectively. Adverse effects were present in both groups; however, there was no statistically significant difference between groups.
CONCLUSION: Using two doses of morphine instead of one is a safe and effective method for pain reduction in isolated limb trauma. We recommend performing a second injection of 0.05 mg/kg morphine 30 minutes after the initial standard dose of 0.10 mg/kg to decrease pain in these patients.

Keywords: Acute pain, emergency medicine, randomized controlled trial.


Ekstremite yaralanması olan hastalarda intravenöz 0.10 mg/kg veya 0.15 mg/kg morfin sülfat ile akut ağrı tedavisi: Randomize çift kör plasebo kontrollü çalışma

Davood Farsi1, Mitra Movahedi2, Peyman Hafezimoghadam3, Saeed Abbasi3, Abtin Shahlaee4, Vafa Rahimi Movaghar4
1Hazrat-e-rasool Akram Medical Complex, Tehran University Of Medical Sciences, Tehran, Iran
2Shahid Mohammadi Hospital, Hormozgan University Of Medical Sciences, Bandar Abbas, Iran
3Department Of Emergency Medicine, Tehran University Of Medical Sciences, Tehran, Iran
4Sina Trauma And Surgery Research Center, Sina Hospital, Tehran University Of Medical Sciences, Tehran, Iran

AMAÇ: Akut ekstremite yaralanması olan hastalarda erişkin acil serviste yapılan iki ayrı morfin dozunun ağrı giderimi ve güvenliliğini karşılaştırmak.
GEREÇ VE YÖNTEM: Opiyoit analjesisine gerek duyan 200 acil servis hastası randomize olarak iki gruba ayrıldı. Bu randomize çift-kör, plasebo kontrollü çalışmada intravenöz yolla 0.10 mg/kg dozda morfin ve daha sonra hastaların bir bölümüne 0.05 mg/kg IV dozda morfin veya aynı miktarda plasebo verildi. Başlangıçta (0.10 mg/kg morfin vermeden önce), 30 (çalışma ilacı verilmeden hemen önce) ve 60 dakika sonra Görsel Analog Ölçekle ağrının şiddet derecesi ve yan etkiler değerlendirildi.
BULGULAR: Başlangıca göre 30. dakikada önemli bir farklılık saptanmadı. Morfinin 0.15 mg/kg dozda yapıldığı grupta diğer gruba (0.10 mg/kg doz grubu) göre bir saat sonra ağrı anlamlı derecede azalmıştı (p<0.05). Bu grubun ağrı skorunda önemli bir iyileşme vardı (p<0.05). Girişim ve kontrol grubunda ağrı sırasıyla %52.70 ve %35.82 oranında azalmıştı. Her iki grupta gözlemlenen yan etkiler açısından istatistiksel açıdan anlamlı bir fark yoktu.
TARTIŞMA: İki morfin dozu yerine tek doz morfin uygulaması ekstremite yaralanmalarında ağrı giderimi açısından güvenli ve etkili bir yöntemdir. Bu hastalarda ağrıyı azaltmak için ilk standart 0.10 mg/kg dozdan 30 dakika sonra 0.05 mg/kg dozda morfin verilmesini önermekteyiz.

Anahtar Kelimeler: Akut ağrı, acil tıp, randomize kontrollü çalışma.


Davood Farsi, Mitra Movahedi, Peyman Hafezimoghadam, Saeed Abbasi, Abtin Shahlaee, Vafa Rahimi Movaghar. Acute pain management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine sulfate in limb traumatized patients: a randomized double-blinded placebo-controlled trial. Ulus Travma Acil Cerrahi Derg. 2013; 19(5): 398-404

Corresponding Author: Vafa Rahimi Movaghar, Iran


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