Open Access Open Access  Restricted Access Subscription or Fee Access

Two milligrams IV hydromorphone is efficacious for treating pain but is associated with oxygen desaturation

Andrew K. Chang, MD, MS, Polly E. Bijur, PhD, Antonio Napolitano, MD, Jason Lupow, MD, E. John Gallagher, MD

Abstract


Objective: To evaluate the safety and efficacy of a single dose of 2 mg IV hydromorphone administered to emergency department patients in acute severe pain.
Design: Prospective interventional.
Setting: Urban academic emergency department.
Patient, participants: Nonelderly adults (21-64 years old) with acute severe pain and baseline oxygen saturation (SO2)≥95 percent.
Interventions: Two milligrams IV hydromorphone administered over 2-3 minutes.
Main outcome measures: The primary outcome was use of naloxone as a reversal agent. Secondary outcomes included degree of pain relief as measured on a numerical rating scale, frequency of oxygen desaturation (SO2 < 95 percent), and side effects.
Results: Of the 269 patients, none received IV naloxone. Median pain scores fell from 10 (worst pain possible) at baseline to 1 within 5 minutes and to 0 (no pain) at 30 minutes. SO2 was ≥95 percent at all time points in 68 percent of patients (95 percent CI 62-73 percent), while 26 percent (95 percent CI 21-32 percent) had one or more SO2 levels between 90-94 percent, and 6 percent (95 percent CI 4-10 percent) had SO2 values below 90 percent at one or more time points. The lowest SO2 was 82 percent. The incidence of nausea and vomiting were 16 percent and 7 percent, respectively.
Conclusions: Two milligrams IV hydromorphone provides efficacious and rapid pain relief in nonelderly adults presenting to the ED with acute severe pain. However, oxygen desaturation below 95 percent occurred in about one third of patients. Although no noticeable clinical signs of hypoxemia occurred, a conservative interpretation of this finding suggests that 2 mg IV hydromorphone is too much opioid to be given routinely to patients in pain as a single initial dose.

Keywords


acute, pain, hydromorphone, emergency department, efficacy, safety

Full Text:

PDF

References


Wilson JE, Pendelton JM: Oligoanalgesia in the emergency department. Am J Emerg Med. 1989; 7: 620-623.

Tanabe P, Buschmann M: A prospective study of ED pain management practices and the patient’s perspective. J Emerg Nurs. 1999; 25: 171-177.

Ducharme J, Barber C: A prospective blinded study on emergency pain assessment and therapy. J Emerg Med. 1995; 13: 571-575.

Guru V, Dubinsky I: The patient versus caregiver perception of acute pain in the emergency department. J Emerg Med. 2000; 18: 7-12.

Lewis LM, Lasater LC, Brooks CB: Are emergency physicians too stingy with analgesics? South Med J. 1994; 87: 7-9.

Selbst SM, Clark M: Analgesic use in the emergency department. Ann Emerg Med. 1990; 19: 1010-1013.

Friedland LR, Pancioli AM, Duncan KM: Pediatric emergency department analgesic practice. Pediatr Emerg Care. 1997; 13: 103-106.

Jantos TJ, Paris PM, Menegazzi JJ, et al.: Analgesic practice for acute orthopedic trauma pain in Costa Rican emergency departments. Ann Emerg Med. 1996; 28: 145-150.

Petrack EM, Christopher NC, Kriwinsky J: Pain management in the emergency department: Patterns of analgesic utilization. Pediatrics. 1997; 99: 711-714.

Salomone J, Price S, Watson W: A prospective evaluation of acute emergency department pain management. Am J Pain Manage. 1995; 5: 80-83.

Rupp T, Delaney KA: Inadequate analgesia in emergency medicine. Ann Emerg Med. 2004; 43: 494-503.

Alexander J, Manno M: Underuse of analgesia in very young pediatric patients with isolated painful injuries. Ann Emerg Med. 2003; 41: 617-622.

Brown JC, Klein EJ, Lewis CW, et al.: Emergency department analgesia for fracture pain. Ann Emerg Med. 2003; 42: 197-205.

Vassiliadis J, Hitos K, Hill CT: Factors influencing prehospital and emergency department analgesic administration to patients with femoral neck fractures. Emerg Med. 2003; 14: 261-266.

Decosterd I, Hugli O, Tamches E, et al.: Oligoanalgesia in the emergency department: Short-term beneficial effects of an education program on acute pain. Ann Emerg Med. 2007; 50(4): 462-471.

Ritsema TS, Kelen GD, Pronovost PJ, et al.: The national trend in quality of emergency department pain management for long bone fractures. Acad Emerg Med. 2007; 14: 163-169.

Karwowski-Soulié F, Lessenot-Tcherny S, Lamarche-Vadel A, et al.: Pain in an emergency department: An audit. Eur J Emerg Med. 2006; 13: 218-224.

Goldman RD, Crum D, Bromberg R, et al.: Analgesia administration for acute abdominal pain in the pediatric emergency department. Pediatr Emerg Care. 2006; 22: 18-21.

Stalnikowicz R, Mahamid R, Kaspi S, et al.: Undertreatment of acute pain in the emergency department: A challenge. Int J Qual Health Care. 2005; 17: 173-176.

Todd KH, Ducharme J, Choiniere, et al.: PEMI study group. Pain in the emergency department: Results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007; 8: 460-466.

Chang AK, Bijur PE, Kenny MK, et al.: Safety and efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: A randomized clinical trial. Ann Emerg Med. 2006; 48: 164-172.

Bijur PE, Latimer CT, Gallagher EJ: Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003; 10: 390-392.

Birnbaum A, Esses D, Bijur PE, et al.: Randomized doubleblind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007; 49: 445-453.

Gallagher EJ, Esses D, Lee C, et al.: Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med. 2006; 48: 150-160.

McCaig LF, Burt CW: National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. Advance data from vital and health statistics; no 358. Hyattsville, Maryland: National Center for Health Statistics, 2005.

Hardman JG, Limbird LE, Gilman AG: Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 10th ed. New York, NY: McGraw-Hill Professional, 2001.

Shapiro BA, Peruzzi WT: Respiratory care. In Miller RM (ed.): Anesthesia, 5th ed. Philadelphia: Churchill Livingstone, 2000.




DOI: https://doi.org/10.5055/jom.2009.0008

Refbacks

  • There are currently no refbacks.