Compliance with a Morphine Protocol and Effect on Pain Relief in Out-of-Hospital Patients

• Published in: The Journal of emergency medicine 2008-04, Vol.34 (3), p.305-310
• Main Authors: Ricard-Hibon, Agnes, MD, Belpomme, Vanessa, MD, Chollet, Charlotte, MD, Devaud, Marie-Laure, MD, Adnet, Frederic, MD, PHD, Borron, Stephen, MD, PHD, Mantz, Jean, MD, PHD, Marty, Jean, MD
• Format: Article
• Language: English
• Subjects: analgesia; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; compliance with protocol; Emergency; Emergency Medical Services - statistics & numerical data; Female; France; Guideline Adherence - statistics & numerical data; Humans; Male; Middle Aged; morphine; Morphine - administration & dosage; Morphine - adverse effects; out-of-hospital; Pain - classification; Pain - drug therapy; Pain Measurement; Patient Satisfaction; Prospective Studies; relief; Time Factors
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2007.06.003

Abstract This study was carried out to evaluate the compliance with a morphine protocol and its effects on pain relief in pre-hospital care. In this prospective study, pain intensity was evaluated by the Visual Analog Scale (VAS) from the beginning and every 5 min until hospital arrival (Tend). Group 1: No major deviation from the protocol (intravenous morphine as a first bolus of 0.05 mg/kg followed by repeated boluses every 5 min until VAS ≤ 30 mm). Group 2: Major deviation from the protocol. There were 216 patients included. The mean dose of morphine was 9.0 ± 5.7 mg. The morphine protocol was respected in 123 patients (57%). The mean VAS score was significantly better at Tend in Group 1 vs. Group 2 (27.8 ± 21.1 mm vs. 37.8 ± 22.1 mm, respectively), the degree of pain relief was significantly better (73% vs. 53%, respectively) and the initiation time for pain relief was significantly shorter in Group 1 vs. Group 2 (10 min [5–15] vs. 15 min [10–26], respectively). Satisfaction was significantly better in patients expressing pain relief than in unrelieved patients (94% vs. 61%, respectively). Out-of-hospital pain management using morphine depends on careful attention to dosage and the time interval between re-injections. Emergency teams may employ these data to improve the quality of pain relief in the field.