SAFETY ASSESSMENT OF HIGH-DOSE NARCOTIC ANALGESIA FOR EMERGENCY DEPARTMENT PROCEDURES

Study objective: To evaluate the safety of high-dose IV narcotics in p atients requiring analgesia for painful emergency department procedure s. Design: Prospective multicenter clinical trial. Setting: Five adult urban EDs. Methods and measurements: All patients received IV meperid ine (1.5 to 3.0 mg/kg) titrated to analgesia followed by a painful pro cedure. Vital signs and alertness scale were recorded at regular inter vals, and patients were observed for four hours. Adverse events were m onitored and documented. Comparisons between baseline and postanalgesi a intervals were made with a repeated measures ANOVA (Dunnett's test), Results: Although statistically significant changes in vital signs an d alertness scale occurred, they were not clinically significant. Opia te reversal with naloxone was not needed in any patient, and no signif icant respiratory or circulatory compromise occurred. Conclusion: This study of 72 patients demonstrates that high-dose narcotic analgesia i s appropriate, well tolerated, and safe when used in selected patients before painful procedures in the ED. Narcotic antagonists and resusci tation equipment nonetheless should be available to maximize safety.