Morphine Dosing in Acute Pain: How Much Is Enough?


Underdosing of opioid analgesia is a significant
problem in emergency medicine. Although many dosing regimens for
intravenous morphine have been studied, 0.10 mg/kg generally is
recommended as an acceptable starting dose for treating patients with
acute pain. Unfortunately, many physicians start much lower. In a
prospective, randomized, placebo-controlled, double-blind study,
researchers compared the effects of morphine at doses of 0.10 mg/kg and
0.15 mg/kg in 280 adult patients (age range, 21-65) who presented with
pain of less than 7 days' duration and who were deemed to require
opioid analgesia by an attending emergency physician.

All patients received an initial dose of 0.10 mg/kg of morphine. After
30 minutes, those randomized to the higher dose received 0.05 mg/kg of
morphine, while the lower-dose group received placebo. Pain scores were
assessed at baseline, 30 minutes, and 60 minutes using a standardized
numeric pain scale (0 = no pain, 10 = worst pain possible).

At 30 minutes, reductions in pain were similar in the two groups. Both
groups had further pain reduction at 60 minutes, but the higher-dose
group had a small, statistically significant but clinically
insignificant greater reduction in pain than the lower-dose group
(between-group difference, 0.4; 95% confidence interval, 0.0-0.9).
Adverse events were similar in the two groups.

Source: http://www.medscape.com/viewarticle/558059?src=mp

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