Comparison of Divided Dose versus Bolus Administration Morphine Sulfate for Management of Acute Pain in Traumatic Fracture in Patients Admitted to Emergency Department

IF 0.4 Q4 PHARMACOLOGY & PHARMACY

Advances in Pharmacology and Pharmacy Pub Date : 2019-07-01 DOI:10.13189/APP.2019.070302

S. M. Hosseininejad, Fatemeh Jahanian, Iraj Goli Khatir, Seyed Hossein Montazer, F. Bozorgi, Nazanin Nosrati, F. H. Kiabi

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Abstract

Introduction: Pain is one of the most common reasons that patients visit emergency departments. Morphine has been used extensively in pain management but there is no consensus about the effectiveness of method of administration. The aim of this study was to compare the divided dose vs bolus medication form of morphine sulfate for management of acute pain in traumatic fracture. Methods: we designed a randomized double-blind clinical trial. On basis of inclusion and exclusion criteria, 160 patients with acute traumatic fracture were enrolled to the study and randomly divided into two groups. The first group (bolus group) received 0.1mg/kg morphine and then 0.1mg/kg normal saline every 5 minutes. The second group (titration group) received 0.1mg/kg of morphine in divided doses every 5 minutes. All injections were intravenously. The primary outcome was pain and before of injection, 15 minutes and 60 minutes after injection were recorded. Data were analyzed using SPSS 19. Results: 77 patients included 49 (63.6%) male with mean age of 47.42 ± 13.15 years were in titration group and 83 patients included 47 males (56.6%) with mean age of 52.40 ± 15.62 years were in bolus group. The complication rate was significantly higher in bolus group (75.9% vs 53.2%, P <0.0001). The need to extra morphine injection in bolus and titration group were 62.7% and 28.6%, respectively (P <0.0001). The mean pain score before and at 15 and 60 minutes after injection were 9.56 ± 1.03, 6.61 ± 1.86 and 1.85 ± 1.13 in titration group and 9.76 ± 0.48, 6.53 ± 1.59 and 0.61 ± 0.46 in bolus group, respectively. The pain score was significantly lower in titration group at 60 minutes after injection (P <0.0001). Discussion: The results of this study showed that titration of morphine are a safe and effective method in compared with bolus administration to reducing acute pain in traumatic fracture.

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分剂量硫酸吗啡与大剂量硫酸吗啡治疗急诊科创伤性骨折急性疼痛的比较

疼痛是患者到急诊科就诊最常见的原因之一。吗啡已广泛应用于疼痛治疗，但对给药方法的有效性尚无共识。本研究的目的是比较分剂量vs丸药物形式的硫酸吗啡急性疼痛管理的创伤性骨折。方法:设计随机双盲临床试验。根据纳入和排除标准，160例急性外伤性骨折患者被纳入研究，随机分为两组。第一组(丸组)注射吗啡0.1mg/kg，再注射生理盐水0.1mg/kg，每5分钟注射一次。第二组(滴定组)给予吗啡0.1mg/kg，每5分钟分次给药。注射都是静脉注射。主要观察指标为疼痛、注射前、注射后15分钟和60分钟。数据采用SPSS 19进行分析。结果:滴剂组77例49例(63.6%)，男性，平均年龄47.42±13.15岁;丸剂组83例47例(56.6%)，平均年龄52.40±15.62岁。大剂量组并发症发生率明显高于大剂量组(75.9% vs 53.2%， P <0.0001)。大剂量组和滴注组需要额外注射吗啡的比例分别为62.7%和28.6% (P <0.0001)。注射前、注射后15分钟、60分钟的平均疼痛评分，滴注组分别为9.56±1.03、6.61±1.86、1.85±1.13，大剂量组分别为9.76±0.48、6.53±1.59、0.61±0.46。注射后60min，滴注组疼痛评分明显低于滴注组(P <0.0001)。讨论:本研究结果表明，与大剂量给药相比，吗啡滴定是一种安全有效的减轻外伤性骨折急性疼痛的方法。

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Advances in Pharmacology and Pharmacy PHARMACOLOGY & PHARMACY-

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