What morphine titration regimen should be adopted in the emergency room?

Intravenous morphine titration is an attractive therapeutic technique in the treatment of severe acute pain in the emergency department. However, despite the various therapeutic models that have been proposed, no universal titration regimen is currently available. It was decided to compare the efficacy and safety of two morphine titration protocols in the emergency department in a prospective randomized controlled double-blind study. Patients were randomized into two groups A and B who received an initial intravenous bolus of 0.05mg/kg Morphine and then according to randomization they received either a 0.05mg/kg titration (protocol A), or a 0.025mg/kg titration (protocol B) every 5 minutes. The primary endpoint was the VAS at T30 minutes where no significant difference was noted between the two groups. The most common adverse events were nausea followed by vomiting in both groups, with an increase in side effects in group A. These results should be confirmed by other prospective studies.