Titrated Versus High and Low Dose Nebulized Morphine to Reduce Pain in Emergency Settings

Efficacy and Safety of Nebulized Morphine Given at Two Different Doses Compared to Intravenous Morphine in Post-traumatic Acute Pain: a Randomized Controlled Double Blind Study

The investigators test a different technique using morphine to improve pain relief in patient visiting the emergency department with acute trauma pain, for this we are comparing three different methods of morphine administration:

• intravenous titrated morphine
• low dose nebulized morphine and
• high dose nebulized morphine

Trauma patients are frequent in emergency department settings, and often require urgent care.

taking care of this patients consists on taking care of their pain and then the specific treatment of their traumatic lesions.

actually, the most used medicine and most efficient one in treating pain is morphine, it's mechanism of action is by acting on receptors located on neuronal cell membranes and inhibit neurotransmitter release.

The most applied administration root of morphine is by intravenous (IV) titration or IV continuous perfusion, but until now, there is no clear recommendation concerning the superiority of this root over other administration techniques such as nebulization.

In this study we aimed to investigate the efficiency, the feasibility and the tolerance of three morphine administration roots in patients with acute traumatic pain and to clarify the most adequate one to apply in emergency department settings.

Inclusion Criteria:

• patients older than 8 years and less than 50 years
• patients who consult emergency department for sever pain after an immediately trauma

Exclusion Criteria:

• Glasgow coma scale <14
• inability to cooperate
• hypotension with systolic blood pressure< 90mmhg
• bradypnea<12cpm
• SAO2<90%
• polytrauma
• nasal trauma
• rhinitis
• nasal obstruction
• allergy to opioids