Morphine Dosing in Acute Pain: How Much Is Enough?

[Admin]

Underdosing of opioid analgesia is a significant problem in emergency medicine. Although many dosing regimens for intravenous morphine have been studied, 0.10 mg/kg generally is recommended as an acceptable starting dose for treating patients with acute pain. Unfortunately, many physicians start much lower. In a prospective, randomized, placebo-controlled, double-blind study, researchers compared the effects of morphine at doses of 0.10 mg/kg and 0.15 mg/kg in 280 adult patients (age range, 21-65) who presented with pain of less than 7 days' duration and who were deemed to require opioid analgesia by an attending emergency physician.

All patients received an initial dose of 0.10 mg/kg of morphine. After 30 minutes, those randomized to the higher dose received 0.05 mg/kg of morphine, while the lower-dose group received placebo. Pain scores were assessed at baseline, 30 minutes, and 60 minutes using a standardized numeric pain scale (0 = no pain, 10 = worst pain possible).

At 30 minutes, reductions in pain were similar in the two groups. Both groups had further pain reduction at 60 minutes, but the higher-dose group had a small, statistically significant but clinically insignificant greater reduction in pain than the lower-dose group (between-group difference, 0.4; 95% confidence interval, 0.0-0.9). Adverse events were similar in the two groups.

Source: http://www.medscape.com/viewarticle/558059?src=mp