Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial

Mohammad Davood Sharifi; Hamid Zamani Moghadam Doloo; Amir Masoud Hashemian; Javad Tootian Tourghabe; Behrang Rezvani Kakhki; Sasan Johari Teimoori; Niaz Mohammad Jafari Chokan; Hamid Reza Noroozi

doi:10.19082/2432

Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial

Electron Physician. 2016 May 25;8(5):2432-5. doi: 10.19082/2432. eCollection 2016 May.

Authors

Mohammad Davood Sharifi¹, Hamid Zamani Moghadam Doloo², Amir Masoud Hashemian¹, Javad Tootian Tourghabe², Behrang Rezvani Kakhki², Sasan Johari Teimoori³, Niaz Mohammad Jafari Chokan², Hamid Reza Noroozi⁴

Affiliations

¹ M.D of Emergency Medicine, Associate Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
² M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
³ M.D of Emergency Medicine, Department of Emergency, Valieasr Hospital, Birjand University of Medical Sciences, Birjand, Iran.
⁴ M.D of Radiology, Assistant Professor, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

PMID: 27382455
PMCID: PMC4930265
DOI: 10.19082/2432

Abstract

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.

Keywords: CT scan; Cervical spine; Morphine; Trauma.