Acute Pain
Conditions
Keywords
pain, analgesia, morphine, PCA, Nurse
Brief summary
Intense acute pain is a common reason for Emergency admittance and its management is one of the major public health goals. In the recommendations formalized experts, it is recommended to use a protocol titration with morphine bolus of 2 mg (for patients less than 60 kg) or 3 mg (for patients over 60 kg) repeated every 5 minutes with a target of the Visual Analog Scale less than or equal to 30. Despite these specific recommendations and a broad awareness of the teams, management of pain remains to be improved, the major difficulty of morphine titration at the emergency department being the availability of paramedical personnel to perform revaluations and reinjection. Thus, effective analgesia would be obtained in 50% of cases to 30 minutes. The investigators want to study the self-controlled morphine titration by the patient by a mechanical device for single use (efficacy/safety).
Interventions
DEVICETitration of morphine by Patient Controlled Analgesy
PCA is never used for titration but only for relay of titration. Self-controlled analgesia by PCA is our intervention.
Sponsors
University Hospital, Angers
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Admission to an emergency department * Acute pain (Visual Analog Scale \> 60) * Able to assess pain using the numerical scale * Prescription of morphine titration
Exclusion criteria
* Physical or mental disorders limiting the understanding and / or use of a PCA * History of allergy to morphine / hypersensitivity to any component * Long-term treatment morphine * Opioid therapy administered prior to inclusion * Analgesic treatment level 2 (codeine, tramadol, nefopam ...) administered prior to inclusion or planned * History of Substance Abuse * Severe respiratory insufficiency * Severe hepatic impairment * Head trauma * Intracranial hypertension * Uncontrolled epilepsy * Pregnant or lactating * Patient jailed * Incapacitated adult under guardianship * Incapable of giving informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual Analog Scale <30 | 30min | Evaluate the effectiveness of the analgesia of morphine titration self-controlled by the patient using a PCA device for single use (PCA group) opposing to an opioid titration carried out by the nurse (group 'Control') |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate the effectiveness in the group Patient Controlled Analgesy | 4h | * time to obtain effective analgesia from prescirption * consumption of morphine * Visual Analog Scale evolution * percentage of patients relieved defined by VAS \<40, 1 hour after the prescription of opioid titration |
| Satisfaction | 4h | * patient satisfaction * nurse satisfaction * time to prepare morphine titration |
Other
| Measure | Time frame | Description |
|---|---|---|
| Assess the safety in the group Patient Controlled Analgesy | 4h | * adverse events du to morphine * adverse events du to medical/nursing support |
Countries
France
Outcome results
None listed