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Am J Emerg Med. 2014 Jun;32(6):655-9. doi: 10.1016/j.ajem.2014.01.048. Epub 2014 Feb 4.

Does midazolam enhance pain control in prehospital management of traumatic severe pain?

Author information

1
Quimper Hospital CHIC, Emergency Department SMUR, Quimper 29000.
2
INSERM CIC 0502, Brest Medical University Hospital, Brest 29200.
3
Brest Medical University Hospital, Brest 29200.
4
Nantes Medical University Hospital, SAMU, Nantes 44000.
5
INSERM CIC 0502, Brest Medical University Hospital, Brest 29200. Electronic address: zarrin.alavi@chu-brest.fr.

Abstract

PURPOSE:

Midazolam comedication with morphine is a routine practice in pre and postoperative patients but has not been evaluated in prehospital setting. We aimed to evaluate the comedication effect of midazolam in the prehospital traumatic adults.

METHODS:

A prehospital prospective randomized double-blind placebo-controlled trial of intravenous morphine 0.10 mg/kg and midazolam 0.04 mg/kg vs morphine 0.10 mg/kg and placebo. Pain assessment was done using a validated numeric rating scale (NRS). The primary end point was to achieve an efficient analgesic effect (NRS≤3) 20 minutes after the baseline. The secondary end points were treatment safety, total morphine dose required until obtaining NRS≤3, and efficient analgesic effect 30 minutes after the baseline.

FINDINGS:

Ninety-one patients were randomized into midazolam (n=41) and placebo (n=50) groups. No significant difference in proportion of patients with a pain score≤3 was observed between midazolam (43.6%) and placebo (45.7%) after 20 minutes (P=.849). Secondary end points were similar in regard with proportion of patients with a pain score≤3 at T30, the side effects and adverse events except for drowsiness in midazolam vs placebo, 43.6% vs 6.5% (P<.001). No significant difference in total morphine dose was observed, that is, midazolam (14.09 mg±6.64) vs placebo (15.53 mg±6.27) (P=.315).

CONCLUSIONS:

According to our study, midazolam does not enhance pain control as an adjunctive to morphine regimen in the management of trauma-induced pain in prehospital setting. However, such midazolam use seems to be associated with an increase in drowsiness.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01731184.

PMID:
24613655
DOI:
10.1016/j.ajem.2014.01.048
[Indexed for MEDLINE]

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