Bounes Vincent, Charpentier Sandrine, Houze-Cerfon Charles-Henri, Bellard Cédric, Ducassé Jean Louis
SAMU 31, Pôle de médecine d'urgences, Hôpitaux Universitaires, 31059 Toulouse cedex 9, France.
Am J Emerg Med. 2008 Feb;26(2):148-54. doi: 10.1016/j.ajem.2007.04.020.
We aimed to determine the best intravenous morphine titration protocol by comparing 2 protocols for prehospital treatment of patients with severe acute pain.
Eligible patients with a numerical rating scale (NRS) score of 60/100 or higher were randomly allocated to receive either 0.05 mg/kg morphine then 0.025 mg/kg every 5 minutes (group A) or 0.1 mg/kg morphine then 0.05 mg/kg every 5 minutes (group B) intravenously. The protocol-defined primary outcome measure was the percentage of patients with pain relief (with a NRS score of 30/100 or lower) 30 minutes after the first injection.
A total of 106 consecutive patients were randomized. Thirty minutes after the injection, 66% of the patients in group A had an NRS of 30 or lower vs 76% of those in group B (P = .25). Ten minutes after the injection, 17% of the patients in group A had an NRS score of 30 or lower vs 40% of those in group B, (odds ratio, 3.4; 95% confidence interval, 1.3-8.8; P < .01). Patients in group B were significantly more satisfied with their analgesia. In addition, there were no serious complications in either group. However, patients in group B did experience almost twice the incidence of adverse effects overall and in particular 4 times the level of emesis, although neither of these observations were statistically significant. Using univariate and multivariate analysis, only an initial NRS score of 100 was an independent predictive factor for failure of analgesia (odds ratio, 0.125; 95% confidence interval, 0.02-0.68; P < .05).
The high-dose morphine regimen showed a similar analgesic response pattern to the low-dose one in severe acute pain in a prehospital setting. Patients in the high-dose group were more likely to experience pain relief 10 minutes after the injection. In the interests of achieving rapid pain relief, an initial dose of 0.05 mg/kg should no longer be recommended for treating severe acute pain in a prehospital setting. Another important message arising from our study is that a regimented dose of morphine, with an initial dose and strictly administered lower doses at regular intervals, is safe in the prehospital setting.
我们旨在通过比较两种用于院前治疗严重急性疼痛患者的方案，确定最佳的静脉注射吗啡滴定方案。
符合条件的数字评分量表（NRS）评分在60/100或更高的患者被随机分配，静脉注射0.05mg/kg吗啡，然后每5分钟注射0.025mg/kg（A组），或0.1mg/kg吗啡，然后每5分钟注射0.05mg/kg（B组）。方案定义的主要结局指标是首次注射后30分钟疼痛缓解（NRS评分30/100或更低）的患者百分比。
共有106例连续患者被随机分组。注射后30分钟，A组66%的患者NRS评分为30或更低，而B组为76%（P = 0.25）。注射后10分钟，A组17%的患者NRS评分为30或更低，而B组为40%（优势比为3.4；95%置信区间为1.3 - 8.8；P < 0.01）。B组患者对镇痛效果的满意度明显更高。此外，两组均未出现严重并发症。然而，B组患者总体不良反应发生率几乎是A组的两倍，尤其是呕吐发生率是A组的4倍，尽管这两项观察结果在统计学上均无显著意义。使用单因素和多因素分析，只有初始NRS评分为100是镇痛失败的独立预测因素（优势比为0.125；95%置信区间为0.02 - 0.68；P < 0.05）。
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