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

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.

Ekstremite yaralanmasý olan hastalarda intravenöz 0.10 mg/kg veya 0.15 mg/kg morfin sülfat ile akut aðrý tedavisi: Randomize çift kör plasebo kontrollü çalýþma

AMAÇ: Akut ekstremite yaralanmasý olan hastalarda eriþkin acil serviste yapýlan iki ayrý morfin dozunun aðrý giderimi ve güvenliliðini karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Opiyoit analjesisine gerek duyan 200 acil servis hastasý randomize olarak iki gruba ayrýldý. Bu randomize çift-kör, plasebo kontrollü çalýþmada intravenöz yolla 0.10 mg/kg dozda morfin ve daha sonra hastalarýn bir bölümüne 0.05 mg/kg IV dozda morfin veya ayný miktarda plasebo verildi. Baþlangýçta (0.10 mg/kg morfin vermeden önce), 30 (çalýþma ilacý verilmeden hemen önce) ve 60 dakika sonra Görsel Analog Ölçekle aðrýnýn þiddet derecesi ve yan etkiler deðerlendirildi.
BULGULAR: Baþlangýca göre 30. dakikada önemli bir farklýlýk saptanmadý. Morfinin 0.15 mg/kg dozda yapýldýðý grupta diðer gruba (0.10 mg/kg doz grubu) göre bir saat sonra aðrý anlamlý derecede azalmýþtý (p<0.05). Bu grubun aðrý skorunda önemli bir iyileþme vardý (p<0.05). Giriþim ve kontrol grubunda aðrý sýrasýyla %52.70 ve %35.82 oranýnda azalmýþtý. Her iki grupta gözlemlenen yan etkiler açýsýndan istatistiksel açýdan anlamlý bir fark yoktu.
TARTIÞMA: Ýki morfin dozu yerine tek doz morfin uygulamasý ekstremite yaralanmalarýnda aðrý giderimi açýsýndan güvenli ve etkili bir yöntemdir. Bu hastalarda aðrýyý azaltmak için ilk standart 0.10 mg/kg dozdan 30 dakika sonra 0.05 mg/kg dozda morfin verilmesini önermekteyiz.