The Effectiveness and Adverse Events of Morphine versus Fentanyl on a Physician-staffed Helicopter

• Published in: The Journal of emergency medicine 2012-07, Vol.43 (1), p.69-75
• Main Authors: Smith, Michael D., MD, Wang, Yang, MD, Cudnik, Michael, MD, Smith, Dawn A., MA, Pakiela, John, DO, Emerman, Charles L., MD
• Format: Article
• Language: English
• Subjects: Adult; adverse; Air Ambulances - organization & administration; analgesia; analgesics; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Double-Blind Method; efficacy; Emergency; Female; fentanyl; Fentanyl - adverse effects; Fentanyl - therapeutic use; helicopter; Humans; Male; morphine; Morphine - adverse effects; Morphine - therapeutic use; Pain - drug therapy; Pain - etiology; Pain Measurement; prehospital; Pruritus - chemically induced; reactions; Vomiting - chemically induced; Wounds and Injuries - complications
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2011.05.018

Abstract Background Morphine and fentanyl are both frequently used in prehospital trauma patients, but due to limited formulary size, we sought to study whether both drugs should be included. Objectives The purpose of this study was to evaluate the effectiveness and safety of fentanyl as compared to morphine for patients requiring analgesic medications for a traumatic injury during transport via a physician-staffed air medical service. Methods Trauma patients were grouped by even and odd days (even - morphine 4 mg, odd - fentanyl 50 μg). Patients were excluded based on age (< 18 or > 64 years), hypotension, inability to communicate a pain score (intubated), or known allergy to the study drugs. During the flight, medical crew assessed numeric pain score, vital signs, and incidence of pruritis or nausea. Results There were 103 patients enrolled in the morphine arm and 97 patients in the fentanyl arm. The mean pain score at the beginning of enrollment was 8.0 ± 2.0 in the morphine arm and 8.0 ± 1.8 in the fentanyl arm. The mean final pain score was 5.8 ± 2.7 in the morphine arm and 5.5 ± 2.4 in the fentanyl arm (n.s. by either t -test or non-parametric testing). There was no significant difference in analgesia between fentanyl and morphine. There were no significant differences in the incidence of pruritis or vomiting between the two groups. Average transport time was 37 ± 8 min in the morphine group, and 43 ± 11 min in the fentanyl group. Average number of morphine doses was 3 ± 1.2. For fentanyl, average number of doses was 3 ± 1.3. Conclusion In our study, there was not a significant difference in analgesic effectiveness between morphine and fentanyl. There was no significant difference in the incidence of adverse effects between the two drugs. Our study suggests that either drug can be used safely with equivalent effectiveness.