Pre-hospital Morphine Titration : Comparison of 0,05 Versus 0,1 mg/kg

• Time to obtain an analgesia, defined by a VRS < or = 30
• Patients' satisfaction with analgesia (pain relief classified as excellent, good, mild or weak)
• Investigators' satisfaction with analgesia (pain relief classified as excellent, good, mild or weak)
• Safety evaluation

Efficacy and safety of morphine titration on acute pain in emergency medical mobile units with initial bolus of 0.1 mg/kg plus 0.05 mg/kg versus morphine titration with initial bolus of 0.05 mg/kg plus 0.025 mg/kg

STUDY OBJECTIVE : Assess the efficacy of a morphine dose of 0.1 mg/kg versus a morphine dose of 0.05 mg/kg in pre-hospital pain METHODS : Consecutive patients with severe, acute pain defined as a verbal rating scale (VRS) of 60/100 or higher may be included. 106 patients at all are required in the study. They will be randomised in two groups : group A will receive an initial intravenous injection of 0.05 mg/kg then injections of 0.025 mg/kg every 5 minutes and group B will receive an initial intravenous injection 0.1 mg/kg then injections of 0.05 mg/kg every 5 minutes. The pain scale will be checked every 5 minutes during 30 minutes. The titration will be stopped before, if the VRS is < or = 30. The patient will be followed during the study until 60 minutes.

• Drug: morphine
  morphine 0.05
• Drug: morphine
  morphine 0.10

• Experimental: 1
  morphine 0.05
  Intervention: Drug: morphine
• Active Comparator: 2
  morphine 0.10
  Intervention: Drug: morphine

• Ricard-Hibon A, Leroy N, Magne M, Leberre A, Chollet C, Marty J. [Evaluation of acute pain in prehospital medicine] Ann Fr Anesth Reanim. 1997;16(8):945-9. French.
• Ricard-Hibon A, Marty J. Prise en charge de la douleur en milieu préhospitalier, In SFAR, Conférences d'actualisation 2001, Paris, Elsevier,2001;pp 709-22
• Bounes V, Charpentier S, Houze-Cerfon CH, Bellard C, Ducassé JL. Is there an ideal morphine dose for prehospital treatment of severe acute pain? A randomized, double-blind comparison of 2 doses. Am J Emerg Med. 2008 Feb;26(2):148-54.

Inclusion Criteria:

• Severe, acute pain defined by a VRS of 60/100 or higher
• Male or female over 18 years
• Cared by a medical emergency care unit
• Written informed consent
• Affiliated to social security

Exclusion Criteria:

• A known opioid or paracetamol hypersensitivity
• Patient not agree ta participate at the study
• Pregnancy
• Uncontrolled epilepsia
• Incapacity to understand the VRS
• Renal, respiratory, or liver disease
• Patients who have received sedative drugs or alcohol (< 6h)
• Acute respiratory, haemodynamic or neurologic failure
• Patients who have already received an analgesic (< 6h)
• Drug addiction
• Patients under protection of justice