Protocolized vs Discretionary Use of Opioids in Acute Pain

Inclusion criteria

• Age 21 to 64 years.
• Pain with onset within 7 days.
• Emergency Department attending physician's judgment that patient's pain warrants use of intravenous opioids.
• Normal mental status.

Exclusion criteria

• Prior use of methadone.
• Use of other opioids, tramadol, or heroin in the past seven days.
• Prior adverse reaction to morphine, hydromorphone, or other opioids.
• Chronic pain syndrome.
• Alcohol intoxication.
• Systolic Blood Pressure < 90 mm Hg.
• Use of monoamine oxidase (MAO) inhibitors in past 30 days.
• Weight less than 100 pounds.
• Baseline room air oxygen saturation less than 95%.
• C02 measurement greater than 46: In accordance with a number of similar studies that we have performed, four subsets of patients will have their CO2 measured using a handheld capnometer prior to enrollment in the study. If the CO2 measurement is greater than 46, then the patient will be excluded from the study. The 4 subsets are as follows:

• All patients who have a history of chronic obstructive pulmonary disease (COPD)
• All patients who have a history of sleep apnea
• All patients who report a history of asthma together with greater than a 20 pack-year smoking history
• All patients reporting less than a 20 pack-year smoking history who are having an asthma exacerbation