Intravenous morphine titration as a rapid and efficient analgesia for adult patients with femoral shaft fractures after injury

Pan, Zhengqi; Qi, Yongjian; Wen, Yinxian; Chen, Liaobin

doi:10.1016/j.ajem.2016.07.027

Cited by 2 publications

(2 citation statements)

References 42 publications

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“…In the oral hydrocodone/acetaminophen group, the dose of the tablet was 5 mg/500 mg (18), and only one dose was given. The method of intravenous administration was reported in a previous study (17). In brief, after multifunctional monitoring and venous channel establishing, morphine was titrated every 5 min by 3-mg increments and pain was evaluated every 5 min until substantial partial remission.…”

Section: Study Protocolmentioning

confidence: 99%

“…The use of an intravenous morphine titration provided a rapid and sufficient pain relief under the minimum effective dose with the least amount of adverse effects (15). It was reported that the onset time of intravenous morphine titration may be as short as 3 min with most of the pain relieved during acute pain management but without any obvious severe adverse events (15)(16)(17). It was suggested that intravenous morphine titration may be used as a reasonable analgesic for moderate to severe pain in the ED, particularly due to its extremely short onset time and sufficient analgesic efficiency.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

Pan

Wen

et al. 2018

Exp Ther Med

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The objective of the present study was to test the hypothesis that intravenous morphine titration provides superior analgesia to oral hydrocodone/acetaminophen for patients with lower extremity displaced fracture in an emergency department (ED) setting. A prospective, randomized clinical trial of ED patients suffering acute lower extremity displaced fracture pain was performed with a total of 206 participants included. After application of exclusion criteria, the cohort comprised 166 patients, 85 of which were randomly allocated to the oral hydrocodone/acetaminophen (5 mg/500 mg) group and 81 to the intravenous morphine titration (every 5 min by 3-mg increments) group. The main outcome was the visual analogue scale (VAS) at different time-points after the first dose of analgesic was administered. Secondary outcomes included the VAS change during the skeletal traction operation and short-term adverse events. The results demonstrated that the initial VSA of the participants was similar at the baseline on arrival at the ED (P=0.2582). At the time-points of 5, 15, 30 min after the first dose of analgesic administered, the intravenous morphine titration group exhibited a greater VAS reduction compared with that in the oral hydrocodone/acetaminophen group (P<0.01). The differences between the 2 groups were not statistically significant at 1 h or thereafter. The incidence of short-term adverse events was similar between the 2 groups but sedation, whose incidence in the morphine group was markedly increased, may not be arbitrarily attributed to adverse events. It was concluded that, compared with oral hydrocodone/acetaminophen, intravenous morphine titration provided a rapid and sufficient pain relief and equivalent short-term adverse events for patients with lower extremity displaced fracture in an ED setting.

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Section: Study Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

Pan

Wen

et al. 2018

Exp Ther Med

Self Cite

View full text Add to dashboard Cite

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Analgesics Administered for Pain During Hospitalization Following Lower Extremity Fracture: A Review of the Literature

Griffioen

OʼBrien²

2018

Journal of Trauma Nursing

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Effective treatment of acute pain during hospitalization following lower extremity fracture is critical to improve short-term patient outcomes including wound healing, stress response, hospital length of stay, and cost as well as minimizing long-term negative patient outcomes such as delayed return to work, disability, and chronic pain. As many patients report moderate to severe pain during hospitalization, identifying the analgesics that most effectively reduces pain is a priority to improve patient outcomes. The purpose of this review was to examine published studies describing patient response to analgesics administered orally (PO) or intravenously (IV) in the immediate hospitalization following lower extremity fracture. PubMed was queried for articles published through May 2017 that included information on type of study, population, fracture site, pain measurement tool, analgesic, and result. Of 514 articles found, eight met the inclusion criteria. Analgesics administered PO or IV were fentanyl, hydromorphone, morphine, remifentanil, diclofenac, ibuprofen, ketorolac, and etoricoxib. Five of the studies focused on comparisons between one or more analgesics and three studies compared an IV analgesic to a regional anesthetic agent. Two studies compared different nonsteroidal anti-inflammatory drugs (NSAIDs). Bupivacaine, lignocaine, and levobupivacaine administered as regional nerve blocks were superior to controlling pain compared with IV fentanyl and IV hydromorphone. IV morphine provided faster and better pain relief compared with IV ibuprofen. Based on the limited data available, regional nerve blocks provided superior pain relief compared with opioids, and opioids provided superior pain relief compared with NSAIDs. Different NSAIDs provided similar pain relief.

show abstract

Intravenous morphine titration as a rapid and efficient analgesia for adult patients with femoral shaft fractures after injury

Cited by 2 publications

References 42 publications

Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

Analgesics Administered for Pain During Hospitalization Following Lower Extremity Fracture: A Review of the Literature

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