Efficacy and safety of nebulized morphine given at two different doses compared to intravenous titrated morphine in trauma pain

Background:Our aim was to compare the efficacy and safety of intravenous (IV) titrated morphine with nebulized morphine given at two different doses in severe traumatic pain. Methods: In a prospective, randomized, controlled double blind study, we included 300 patients with severe traumatic pain. They were assigned to three groups: Neb10 group received 1nebulization of 10 mg morphine, Neb20 group received 1nebulization of 20 mg morphine, repeated every 10 minutes with a maximum of three nebulizations. The IV morphine group received2mg IV morphine repeated every 5 minutes until pain relief. Visual analog scale (VAS) was monitored at baseline, 5, 10, 15, 20, 25, 30 and 60 minutes after the start of drug administration. Treatment success was defined by the percentage of patients in whom VAS decreased more than ≥50% of its baseline value.When this end point was not reached rescue morphine was administered.Pain resolution time was defined by the elapsed time between the start of the protocol and the reach of treatment success criteria. Results: Success rate was significantly better 97%(95%CI 93-100) for Neb20 group compared to Neb10 group[81%(95%CI 73-89)] and IV morphine group [79%(95%CI 6784)]. The lowest resolution time was observed in Neb20 group [20min(95%CI 18-21)]. Side effects were minor and significantly lower in both nebulization groups compared to IV morphine group. Conclusions: Nebulized morphine using boluses of 10 mg has similar efficacy and better safety than IV titrated morphine in patients with severe post traumatic pain. Increasing nebulized boluses to 20 mg increasesthe effectiveness without increasing side effects. Clinicaltrials.gov ID: NCT02200185. AC C EP TE D M AN U SC R IP T ACCEPTED MANUSCRIPT