J Res Clin Med. 2020;8(1): 21.
doi: 10.34172/jrcm.2020.021
  Abstract View: 201
  PDF Download: 120

Original Article

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

Mani Mofidi 1 ORCID logo, Ali Dashti 2, Mahdi Rezai 1, Niloufar Ghodrati 3, Hoorolnesa Ameli 4, hassan Amiri 1* ORCID logo

1 Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Student Research Committee, School of medicine, Iran University of Medical Sciences, Tehran, Iran
3 Hematology and Oncology, Alborz University of Medical Sciences, Karaj, Iran
4 Emergency Medicine Department, Qom University of Medical Sciences, Qom, Iran
*Corresponding Author: Hassan Amiri, Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran, Tel:+989123084676, Email: hasanamiri48@yahoo.com


Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain.

Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables

Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03).

Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

Keywords: Intravenous morphine, Nuebolized morphine, Pain management, Traumatic musculoskeletal pain
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Submitted: 28 Jan 2020
Accepted: 23 Mar 2020
ePublished: 02 Jun 2020
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