Safety and Efficacy of Patient Controlled Analgesia in the Emergency Department

Safety and Efficacy of Patient Controlled Analgesia in the Emergency Department

The aims of this study are to assess efficacy and safety of patient-controlled analgesia (PCA) when applied to the Emergency Department setting and to compare the efficacy and safety of two PCA dosing regimens.

The safety, efficacy, and dosing of PCA will be assessed in a randomized trial with three treatment arms:

1. PCA with 1.0 mg morphine demand dosing every 6 minutes,
2. PCA with 1.5 mg demand dosing every 6 minutes and
3. a non-PCA comparison group.

All patients will receive a loading dose of 0.1 mg/kg morphine. All patients can receive additional analgesics as needed, at the discretion of the provider.

We hypothesize that morphine supplied via PCA will provide superior analgesia without a greater incidence of adverse events when compared to non-PCA pain management; and that PCA demand dosing of 1.5 mg will be superior to 1.0 mg without more adverse events.

Inclusion Criteria:

• Patients presenting to the ED with a chief complaint of abdominal pain of less than or equal to 7 days duration
• Age 18 to 65 years
• Patient deemed by the ED attending physician to require IV opioid analgesia

Exclusion Criteria:

• Current use of prescription or non-prescription opioids
• Long-term use of opioids, chronic pain syndrome
• Clinician suspicion of opioid dependence/abuse
• Clinical suspicion of intoxication
• Pregnancy or breast-feeding
• History of chronic obstructive pulmonary disease, history of sleep apnea, oxygen saturation < 97%
• Systolic blood pressure < 100 mm Hg
• Use of monoamine oxidase inhibitors, phenothiazines, or tricyclic antidepressants
• History of renal insufficiency/renal failure
• Prior allergic reaction to morphine
• Inability to provide informed consent
• Previous entry of patient into study