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Morphine in ED

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https://www.readbyqxmd.com/read/28066825/a-blinded-randomised-placebo-controlled-trial-investigating-the-efficacy-of-morphine-analgesia-for-procedural-pain-in-infants-trial-protocol
#1
Rebeccah Slater, Caroline Hartley, Fiona Moultrie, Eleri Adams, Ed Juszczak, Richard Rogers, Jane E Norman, Chetan Patel, Kayleigh Stanbury, Amy Hoskin, Gabrielle Green
Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often undertreated. To date, few pain-relieving drugs have been tested in infants. Morphine is a potent analgesic that provides effective pain relief in adults, but there is inconclusive evidence for its effectiveness in infants. The purpose of this study is to establish whether oral morphine provides effective analgesia for procedural pain in infants. A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity (ROP) screening and heel lancing provides effective analgesia...
November 15, 2016: Wellcome Open Res
https://www.readbyqxmd.com/read/28059034/midazolam-plus-haloperidol-as-adjuvant-analgesics-to-morphine-in-opium-dependent-patients-a-randomized-clinical-trial
#2
Mohammad Afzalimoghaddam, Maryam Edalatifard, Amir Nejati, Mehdi Momeni, Nader Isavi, Ehsan Karimialavijeh
BACKGROUND: Tolerance to opioids among opium-dependent patients creates obstacles for proper pain management of these patients in the emergency department (ED). The aim of the present study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine analgesia among opium-dependent patients. METHODS: Opium-dependent adults who were admitted to the ED for new-onset severe pain in the limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating scale [NRS]) were recruited...
January 6, 2017: Current Drug Abuse Reviews
https://www.readbyqxmd.com/read/28025373/trends-in-opioid-analgesic-use-in-encounters-involving-physician-trainees-in-u-s-emergency-departments
#3
Maryann Mazer-Amirshahi, Peter M Mullins, Christie Sun, Jesse M Pines, Lewis S Nelson, Jeanmarie Perrone
BACKGROUND: Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved. METHODS: We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27993418/comparison-of-intravenous-ketorolac-at-three-single-dose-regimens-for-treating-acute-pain-in-the-emergency-department-a-randomized-controlled-trial
#4
Sergey Motov, Matthew Yasavolian, Antonios Likourezos, Illya Pushkar, Rukhsana Hossain, Jefferson Drapkin, Victor Cohen, Nicholas Filk, Andrew Smith, Felix Huang, Bradley Rockoff, Peter Homel, Christian Fromm
STUDY OBJECTIVE: Nonsteroidal anti-inflammatory drugs are used extensively for the management of acute and chronic pain, with ketorolac tromethamine being one of the most frequently used parenteral analgesics in the emergency department (ED). The drugs may commonly be used at doses above their analgesic ceiling, offering no incremental analgesic advantage while potentially adding risk of harm. We evaluate the analgesic efficacy of 3 doses of intravenous ketorolac in ED patients with acute pain...
December 16, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27931762/comparison-of-intranasal-ketamine-versus-intravenous-morphine-in-reducing-pain-in-patients-with-renal-colic
#5
Mohammad Reza Farnia, Alireza Jalali, Elnaz Vahidi, Mehdi Momeni, Javad Seyedhosseini, Morteza Saeedi
BACKGROUND: Various drugs have been used to relieve abdominal pain in patients with renal colic. Ketamine is a popular choice as an analgesic. OBJECTIVE: To compare the effectiveness of intranasal (IN) ketamine versus intravenous (IV) morphine in reducing pain in patients with renal colic. METHODS: A randomized double-blind controlled trial was performed in 53 patients with renal colic recruited from the emergency department (ED) in 2015. Finally, 40 patients were enrolled in this study...
November 22, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27899166/pain-management-of-acute-appendicitis-in-canadian-pediatric-emergency-departments
#6
Andrea L Robb, Samina Ali, Naveen Poonai, Graham C Thompson
OBJECTIVES: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). METHODS: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital...
November 30, 2016: CJEM
https://www.readbyqxmd.com/read/27864394/bet-2-low-dose-ketamine-for-acute-pain-in-the-ed
#7
Colby Duncan, Brad Riley
A short cut review was carried out to establish whether low-dose ketamine is better than morphine at safely and effectively reducing pain scores in ED patients with acute pain who do not respond to conventional therapies. One hundred and thirty-two papers were found using the reported searches, of these three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated...
December 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27829367/intranasal-ketamine-for-acute-traumatic-pain-in-the-emergency-department-a-prospective-randomized-clinical-trial-of-efficacy-and-safety
#8
Shachar Shimonovich, Roy Gigi, Amir Shapira, Tal Sarig-Meth, Danielle Nadav, Mattan Rozenek, Debra West, Pinchas Halpern
BACKGROUND: Ketamine has been well studied for its efficacy as an analgesic agent. However, intranasal (IN) administration of ketamine has only recently been studied in the emergency setting. The objective of this study was to elucidate the efficacy and adverse effects of a sub-dissociative dose of IN Ketamine compared to IV and IM morphine. METHODS: A single-center, randomized, prospective, parallel clinical trial of efficacy and safety of IN ketamine compared to IV and IM morphine for analgesia in the emergency department (ED)...
November 9, 2016: BMC Emergency Medicine
https://www.readbyqxmd.com/read/27800541/intravenous-morphine-vs-intravenous-ketofol-for-treating-renal-colic-a-randomized-controlled-trial
#9
Gholamreza Faridaalaee, Neda Mohammadi, Seyedeh Zahra Merghati, Fatemeh Keyghobadi Khajeh, Bahman Naghipour, Mahboob Pouraghaei, Sajjad Ahmadi
INTRODUCTION: The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. METHODS: This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0...
November 2016: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/27787895/regional-nerve-blocks-improve-pain-and-functional-outcomes-in-hip-fracture-a-randomized-controlled-trial
#10
R Sean Morrison, Eitan Dickman, Ula Hwang, Saadia Akhtar, Taja Ferguson, Jennifer Huang, Christina L Jeng, Bret P Nelson, Meg A Rosenblatt, Jeffrey H Silverstein, Reuben J Strayer, Toni M Torrillo, Knox H Todd
OBJECTIVES: To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture. DESIGN: Multisite randomized controlled trial from April 2009 to March 2013. SETTING: Three New York hospitals. PARTICIPANTS: Individuals with hip fracture (N = 161). INTERVENTION: Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82)...
December 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27779484/intravenous-acetaminophen-for-renal-colic-in-the-emergency-department-where-do-we-stand
#11
Billy Sin, Kimberly Koop, Michelle Liu, Jun-Yen Yeh, Pardeep Thandi
BACKGROUND: The efficacy, safety, opioid-sparing effects, and cost-benefit analyses of intravenous (IV) acetaminophen (APAP) in treating renal colic remain controversial. STUDY QUESTION: To evaluate the safety, efficacy, opioid-sparing effects, and cost-benefits of IV APAP in patients who present with renal colic in the emergency department (ED). DATA SOURCES: We systematically searched PubMed (January 1970 to April 2016). STUDY DESIGN: Randomized controlled trials which evaluated IV APAP for renal colic in the ED were eligible...
October 24, 2016: American Journal of Therapeutics
https://www.readbyqxmd.com/read/27624507/a-randomized-controlled-trial-of-a-citywide-emergency-department-care-coordination-program-to-reduce-prescription-opioid-related-emergency-department-visits
#12
Darin Neven, Leonard Paulozzi, Donelle Howell, Sterling McPherson, Sean M Murphy, Becky Grohs, Linda Marsh, Crystal Lederhos, John Roll
BACKGROUND: Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. OBJECTIVES: We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. METHODS: We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized...
September 10, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27615335/trial-results-make-case-for-using-acupuncture-in-pain-relief
#13
(no author information available yet)
A randomised trial of 300 emergency department (ED) patients' responses to titrated morphine or a half-hour acupuncture session was carried out.
September 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/27609854/study-protocol-of-a-randomised-controlled-trial-of-intranasal-ketamine-compared-with-intranasal-fentanyl-for-analgesia-in-children-with-suspected-isolated-extremity-fractures-in-the-paediatric-emergency-department
#14
Stacy L Reynolds, Jonathan R Studnek, Kathleen Bryant, Kelly VanderHave, Eric Grossman, Charity G Moore, James Young, Melanie Hogg, Michael S Runyon
INTRODUCTION: Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage. METHODS AND ANALYSIS: This double-blind, randomised controlled, pilot trial will compare INSD ketamine (1 mg/kg) to IN fentanyl (1...
September 8, 2016: BMJ Open
https://www.readbyqxmd.com/read/27517842/impact-of-emergency-department-care-on-outcomes-of-acute-pain-events-in-children-with-sickle-cell-disease
#15
Amanda M Brandow, Mark Nimmer, Timothy Simmons, T Charles Casper, Lawrence J Cook, Corrie E Chumpitazi, J Paul Scott, Julie A Panepinto, David C Brousseau
The impact of emergency department (ED) treatment on outcomes of sickle cell disease (SCD) acute pain hospitalizations is not well described. We investigated whether length of stay (LOS) and change in health-related quality of life (HRQL) are affected by initial opioid dose and time to administration. We conducted secondary analyses of data from the randomized-controlled Magnesium for children in Crisis (MAGiC) trial. The primary outcome was LOS. Secondary outcome was change in HRQL, assessed using PedsQL SCD Pain and Hurt and Pain Impact Domains measured in ED and at discharge...
December 2016: American Journal of Hematology
https://www.readbyqxmd.com/read/27475042/acupuncture-vs-intravenous-morphine-in-the-management-of-acute-pain-in-the-ed
#16
Mohamed Habib Grissa, Houda Baccouche, Hamdi Boubaker, Kaouthar Beltaief, Nasri Bzeouich, Nizar Fredj, Mohamed Amine Msolli, Riadh Boukef, Wahid Bouida, Semir Nouira
BACKGROUND: Acupuncture is one of the oldest techniques to treat pain and is commonly used for a large number of indications. However, there is no sufficient evidence to support its application in acute medical settings. METHODS: This was a prospective, randomized trial of acupuncture vs morphine to treat ED patients with acute onset moderate to severe pain. Primary outcome consists of the degree of pain relief with significant pain reduction defined as a pain score reduction ≥50% of its initial value...
July 20, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27473610/fentanyl-and-a-novel-synthetic-opioid-u-47700-masquerading-as-street-norco-in-central-california-a-case-report
#17
Patil Armenian, Alexander Olson, Andres Anaya, Alicia Kurtz, Rawnica Ruegner, Roy R Gerona
In 2013 and 2014, more than 700 deaths were attributed to fentanyl and fentanyl analogues in the United States. Of recent concern is the cluster of unintentional fentanyl overdoses because of tablets thought to be "Norco" purchased on the street in Northern California. U-47700 (trans-3,4-dichloro-N-[2-(dimethyl-amino)cyclohexyl]-N-methylbenz-amide) is a nonfentanyl-based synthetic opioid with 7.5 times the binding affinity of morphine to μ-opioid. We report a case of fentanyl and U-47700 intoxication from what was thought to be illicitly purchased Norco...
January 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27342276/enzymatic-debridement-for-the-treatment-of-severely-burned-upper-extremities-early-single-center-experiences
#18
Tomke Cordts, Johannes Horter, Julian Vogelpohl, Thomas Kremer, Ulrich Kneser, Jochen-Frederick Hernekamp
BACKGROUND: Severe burns of hands and arms are complex and challenging injuries. The Standard of care (SOC) - necrosectomy with skin grafting - is often associated with poor functional or aesthetic outcome. Enzymatic debridement (ED) is considered one promising alternative but, until recently, results proved to be highly variable. METHODS: Between 04/2014 and 04/2015, 16 patients with deep partial- to full-thickness burns of the upper extremities underwent enzymatic debridement (ED) in our Burn Center and were evaluated for extent of additional surgery, wound healing, pain management and functional parameters...
June 24, 2016: BMC Dermatology
https://www.readbyqxmd.com/read/27300483/management-of-adults-with-acute-migraine-in-the-emergency-department-the-american-headache-society-evidence-assessment-of-parenteral-pharmacotherapies
#19
REVIEW
Serena L Orr, Benjamin W Friedman, Suzanne Christie, Mia T Minen, Cynthia Bamford, Nancy E Kelley, Deborah Tepper
OBJECTIVE: To provide evidence-based treatment recommendations for adults with acute migraine who require treatment with injectable medication in an emergency department (ED). We addressed two clinically relevant questions: (1) Which injectable medications should be considered first-line treatment for adults who present to an ED with acute migraine? (2) Do parenteral corticosteroids prevent recurrence of migraine in adults discharged from an ED? METHODS: The American Headache Society convened an expert panel of authors who defined a search strategy and then performed a search of Medline, Embase, the Cochrane database and clinical trial registries from inception through 2015...
June 2016: Headache
https://www.readbyqxmd.com/read/27225610/-comparison-of-thoracic-epidural-and-paravertebral-analgesia-for-postoperative-pain-control-after-thoracotomy
#20
Tülün Öztürk, İsmet Topcu, Sadık Yaldız, Alper Özbakkaloğlu, Kıvanç Aşık, Alp Yentürk
OBJECTIVES: In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. METHODS: Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group)...
January 2016: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
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