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

Seyed Mohammad Hosseininejad,Fatemeh Jahanian,Nazanin Nosrati,Farzad Bozorgi,Farshad Hasanzadeh Kiabi,Seyed Hosein Montazer,Iraj Goli Khatir

doi:10.13189/app.2019.070302

Seyed Mohammad Hosseininejad, Fatemeh Jahanian + Show 5 more

Open Access

https://doi.org/10.13189/app.2019.070302

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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.

Highlights

Pain is one of the most common reasons that patients visit emergency departments
The number of patients enrolled in the study was 160 patients; in the group titration 77 and 83 patients were in the bolus group
Of the 77 patients enrolled in the titration Group 49 patients (63.6%) and from 83 patients enrolled in the bolus group 47 patients (56.6%) were male (P = 0.366)

Summary

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. 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. One of the drugs used to control pain are opioids, In the meantime the morphine is more often and that is prescribed intramuscular or intravenous injection just one place that each has its own problems [10], but using alternate forms and its titration can be associated with reduced complications and better patient satisfaction [11].

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