Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma
A double blinded randomized clinical trial
Keywords:
cervical spine, trauma, CT scan, morphineAbstract
Background: Cervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation risks and relatively high cost.
Objective: The focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans.
Methods: This double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups (groups A and B), where group A received intravenous morphine, and group B received a placebo. We measured the pain scores in both groups before giving the medication and 10 minutes afterwards using a visual analog scale (VAS).
Results: As a result of receiving morphine, the patients in group A had significantly lower pain than group B (p-value < 0.001). The average pain score in group A was reduced by 43% versus 23% in group B. However, the most pain reduction was in those in group A with a normal CT scan. The pain score of these patients dropped by 52%.
Conclusions: The findings of this study suggest that patients with a normal radiography may be discharged with a cervical collar without a need for a CT scan if morphine reduces their pain. This is because the pain in these patients stem from the muscles and non-bony structures in the cervical spine area.
Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2013100214872N1
Funding: The authors received no financial support for the research or for the publication of this article.
References
Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, et al. Epidemiology of cervical
spine injury victims. Ann Emerg Med. 2001; 38(6): 12–6. doi: 10.1067/mem.2001.116149, PMID:
Hu R, Mustard CA, Burns C. Epidemiology of incident spinal fracture in a complete population. Spine.
; 21(4): 492–9. doi: 10.1097/00007632-199602150-00016, PMID: 8658254.
Torretti JA, Sengupta DK. Cervical spine trauma. Indian J Orthop. 2007; 41(4): 255-67. doi: 10.4103/0019- 5413.36985, PMCID: PMC2989526.
McCulloch PT, France J, Jones DL, Krantz W, Nguyen TP, Chambers C, et al. Helical Computed
Tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the
cervical spine after high-energy trauma. J Bone Joint Surg Am. 2005; 87: 2388–94. doi:
2106/JBJS.E.00208, PMID: 16264112.
Farsi D, Movahedi M, Hafezimoghadam P, Abbasi S, Shahlaee A, Rahimi-Movaghar V. Acute pain
management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine sulfate in limb traumatized patients: a
randomized double-blinded placebo-controlled trial. Ulus Travma Acil Cerrahi Derg. 2013; 19(5): 398-404.
doi: 10.5505/tjtes.2013.86383, PMID: 24214779.
Sharifi MD, Zamani Moghaddam H, Zakeri H, Ebrahimi M, Saeedian H, Hashemian AM. The Accuracy of
Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging:
Report of 175 Cases. Med Arh. 2015; 69(3): 161-4. doi: 10.5455/medarh.2015.69.161-164, PMCID:
PMC4500294.
Simmons C. Tools for Strengths-Based Assessment and Evaluation. Springer Publishing Company. 2012.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.