Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine in Acute Pain: A Randomized Clinical Trial

Andrew K. Chang, Polly E. Bijur, Robert H. Meyer, Mark K. Kenny, Clemencia Solorzano, E. John Gallagher

Research output: Contribution to journalArticle

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Abstract

Study objective: We compare a standard weight-based dose of intravenous hydromorphone (Dilaudid) to a standard weight-based dose of intravenous morphine in adults presenting to the ED with acute severe pain. Methods: This was a prospective, randomized, double-blind, clinical trial conducted in an academic medical center. Of the 198 adult patients presenting to the ED with acute severe pain who were randomized to receive either intravenous hydromorphone at 0.015 mg/kg or intravenous morphine at 0.1 mg/kg, 191 patients had sufficient data for analysis. The main outcome measure was the difference between the 2 groups in pain reduction at 30 minutes as measured on a validated numeric rating scale. Adverse effects, pain reduction at 5 minutes and 2 hours postbaseline, and additional analgesics and antiemetics were tracked as secondary outcome measures. Results: The mean change of pain from baseline to 30 minutes postbaseline in patients allocated to intravenous hydromorphone was -5.5 numeric rating scale units versus -4.1 in patients allocated to intravenous morphine (difference -1.3; 95% confidence interval -2.2 to -0.5). Adverse effects were similar in both groups, with the exception of pruritus, which did not occur in patients receiving hydromorphone (0% versus 6% [difference -6%; 95% confidence interval -11% to -1%]). No patient required naloxone. Conclusion: For the treatment of acute, severe pain in the emergency department, intravenous hydromorphone at 0.015 mg/kg represents a feasible alternative to intravenous morphine at 0.1 mg/kg.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalAnnals of Emergency Medicine
Volume48
Issue number2
DOIs
StatePublished - Aug 2006

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Hydromorphone
Acute Pain
Morphine
Analgesics
Randomized Controlled Trials
Safety
Pain
Outcome Assessment (Health Care)
Confidence Intervals
Weights and Measures
Antiemetics
Pruritus
Naloxone
Hospital Emergency Service
Clinical Trials

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine in Acute Pain : A Randomized Clinical Trial. / Chang, Andrew K.; Bijur, Polly E.; Meyer, Robert H.; Kenny, Mark K.; Solorzano, Clemencia; Gallagher, E. John.

In: Annals of Emergency Medicine, Vol. 48, No. 2, 08.2006, p. 164-172.

Research output: Contribution to journalArticle

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