Safety and Efficacy of Patient Controlled Analgesia in the Emergency Department

The safety, efficacy, and dosing of PCA will be assessed in a randomized trial with three treatment arms:

• PCA with 1.0 mg morphine demand dosing every 6 minutes,
• PCA with 1.5 mg demand dosing every 6 minutes and
• a non-PCA comparison group.

All patients will receive a loading dose of 0.1 mg/kg morphine. All patients can receive additional analgesics as needed, at the discretion of the provider.

We hypothesize that morphine supplied via PCA will provide superior analgesia without a greater incidence of adverse events when compared to non-PCA pain management; and that PCA demand dosing of 1.5 mg will be superior to 1.0 mg without more adverse events.

Inclusion criteria

• Patients presenting to the ED with a chief complaint of abdominal pain of less than or equal to 7 days duration
• Age 18 to 65 years
• Patient deemed by the ED attending physician to require IV opioid analgesia

Exclusion criteria

• Current use of prescription or non-prescription opioids
• Long-term use of opioids, chronic pain syndrome
• Clinician suspicion of opioid dependence/abuse
• Clinical suspicion of intoxication
• Pregnancy or breast-feeding
• History of chronic obstructive pulmonary disease, history of sleep apnea, oxygen saturation < 97%
• Systolic blood pressure < 100 mm Hg
• Use of monoamine oxidase inhibitors, phenothiazines, or tricyclic antidepressants
• History of renal insufficiency/renal failure
• Prior allergic reaction to morphine
• Inability to provide informed consent
• Previous entry of patient into study