Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury

doi:10.5847/wjem.j.1920-8642.2019.01.004

Abstract

Abstract:

BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.
METHODS: In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients’ demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.
RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients’ satisfaction between the two groups.
CONCLUSION: Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Key words: Fentanyl, Morphine, Opioid addiction, Acute traumatic limb injury, Pain score

Hojat Sheikh Motahar Vahedi, Hadi Hajebi, Elnaz Vahidi, Amir Nejati, Morteza Saeedi. Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury[J]. World Journal of Emergency Medicine, 2019, 10(1): 27-32.

Figures/Tables 3

Figure 1.

Table 1

Table 2

References 21

1	No authors listed. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986; 3:S1-226.
2	Somerville MA. Opioids for chronic pain of non-malignant origin--coercion or consent? Health Care Anal. 1995; 3(1):12-4.
3	Collett BJ. Chronic opioid therapy for non-cancer pain. Br J Anaesth. 2001; 87(1):133-43. pmid: 11460802
4	Shao E, Hughes J, Eley R. The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study. World J Emerg Med. 2017; 8(3):170-6. pmid: 28680512
5	Mehta V, Langford RM. Acute pain management for opioid dependent patients. Anaesthesia. 2006; 61(3):269-76.
6	Miner JR. Pain management. In: Marx JA, editor. Rosen’s emergency medicine. Philadelphia: Elsevier Saunders. 2014; 31-49.
7	Ducharme J. Acute pain management. In: Tintinalli JE, editor. Tintinalli’s emergency medicine. McGraw-Hill; 2016; 231-8.
8	Fine PG, Streisand JB. A review of oral transmucosal fentanyl citrate: potent, rapid and noninvasive opioidanalgesia. J Palliat Med. 1998; 1(1):55-63.
9	Schechter NL, Weisman SJ, Rosenblum M, Bernstein B, Conard PL. The use of oral transmucosal fentanyl citratefor painful procedures in children. Pediatrics. 1995; 95(3):335-9.
10	Shrestha R, Pant S, Shrestha A, Batajoo KH, Thapa R, Vaidya S. Intranasal ketamine for the treatment of patients with acute pain in the emergency department. World J Emerg Med. 2015; 7(1):19-24.
11	Streisand JB, Stanley TH, Hague B, van Vreeswijk H, Ho GH, Pace NL. Oral transmucosal fentanyl citrate premedication in children. Anesth Analg. 1989; 69(1):28-34.
12	Borland M, Jacobs I, King B, O’Brien D. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Acute Pain. 2007; 9(2):100.
13	Mercadante S, Villari P, Ferrera P, Casuccio A, Mangione S, Intravaia G. Transmucosal fentanyl vs. intravenous morphine in doses proportional to basal opioid regimen for episodic-breakthrough pain. Br J Cancer. 2007; 96(12):1828-33.
14	Smith MD, Wang Y, Cudnik M, Smith DA, Pakiela J, Emerman CL. The effectiveness and adverse events of morphine versus fentanyl on a physician-staffed helicopter. J Emerg Med. 2012; 43(1):69-75.
15	Oliver J, Coggins C, Compton P, Hagan S, Matteliano D, Stanton M, et al. American Society for Pain Management nursing position statement: pain management in patients with substance usedisorders. J Addict Nurs. 2012; 23(3):210-22.
16	Mehta V, Langford RM. Acute pain management for opioid dependent patients. Anaesthesia. 2006; 61(3):269-76. pmid: 16480353
17	Compton P, Charuvastra VC, Ling W. Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent. Drug Alcohol Depend. 2001; 63(2):139-46. pmid: 11376918
18	Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas. 2009; 21(3):203-9.
19	Galinski M, Dolveck F, Borron SW, Tual L, Van Laer V, Lardeur JY, et al. A randomized, double-blind study comparing morphine with fentanyl in prehospital analgesia. Am J Emerg Med. 2005; 23(2):114-9.
20	Curtis KM, Henriques HF, Fanciullo G, Reynolds CM, Suber F. A fentanyl-based pain management protocol provides early analgesia for adult trauma patients. J Trauma. 2007; 63(4):819-26.
21	Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg. 1997; 84(3):509-14. pmid: 9052292

Variables	Morphine group	Fentanyl group	P value
Gender, n (%)
Male	141 (92.8)	138 (89.0)	0.25
Female	11 (7.2)	17 (11.0)	0.25
Age (years)	31.8±10.4	31.0±10.7	0.52

Variables	Morphine group					Fentanyl group					P-value
Variables	0 min	5 min	15 min	30 min	60 min	0 min	5 min	15 min	30 min	60 min	0 min	5 min	15 min	30 min	60 min
Systolic blood pressure	123.1±4.5	123.5±4.7	123.8±4.4	124.1±4.7	124.6±4.3	124.5±5.4	123.9±4.8	124.2±4.5	124.0±4.7	124.9±4.3	0.13	0.43	0.40	0.78	0.62
Diastolic blood pressure	73.6±3.9	73.3±3.8	73.2±3.3	73.3±3.6	73.3±3.7	73.1±3.7	73.2±3.8	73.1±3.7	73.0±3.7	73.3±3.8	0.44	0.86	0.75	0.75	0.93
Pulse rate	73.4±2.8	73.2±2.8	73.1±2.9	73.1±2.7	73.2±3.4	73.1±2.9	72.8±2.8	72.7±3.1	72.9±2.7	73.0±3.4	0.52	0.24	0.25	0.52	0.65
Respiratory rate	15.1±1.4	15.1±1.5	14.7±1.3	14.9±1.5	15.0±1.8	15.1±1.7	15.1±1.6	14.8±1.4	15.0±1.6	14.9±1.9	0.94	0.96	0.63	0.85	0.69
O₂ saturation	97.3±1.3	97.3±1.3	97.2±1.2	97.1±1.3	97.3±1.2	97.2±1.3	97.2±1.3	97.1±1.2	97.1±1.2	97.2±1.2	0.37	0.61	0.59	0.71	0.59
Numerical rating score (NRS)	6.8±0.8	2.9±1.2	1.4±0.4	0.7±0.4	0.0±0.0	6.8±0.8	1.8±0.9	1.4±0.5	0.6±0.4	0.0±0.0	0.81	0.00	0.89	0.07	0.17

[1]	Yan-yan Liu, Yu-peng Wang, Ling-yun Zu, Kang Zheng, Qing-bian Ma, Ya-an Zheng, Wei Gao. Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study [J]. World Journal of Emergency Medicine, 2021, 12(2): 105-110.
[2]	Mohammad Reza Farnia, Rasoul Babaei, Farzaneh Shirani, Mehdi Momeni, Majid Hajimaghsoudi, Elnaz Vahidi, Morteza Saeedi. Analgesic effect of paracetamol combined with low-dose morphine versus morphine alone on patients with biliary colic: a double blind, randomized controlled trial [J]. World Journal of Emergency Medicine, 2016, 7(1): 25-29.
[3]	Jean MH Lee, Nina Laxmikantha, Marcus E H Ong, Evelyn Wong, Jeremy CP Wee. Comparing lignocaine-adrenaline-tetracaine gel with lignocaine infiltration for anesthesia during repair of lacerations: A randomized trial [J]. World Journal of Emergency Medicine, 2013, 4(4): 281-284.