Control Group: (n = 90, 53 analysed): morphine (10mg/ml) given 1ml > 30 mins apart, with dose increasing by 0.5ml every 3 hours if no analgesia
Experimental Group: (n = 92, 66 analysed): pethidine (75mg/ml) given 1ml >30 mins apart, does increase by 0.5ml every 3 hours if no analgesia
Comparison Group: (n = 93, 51 analysed): nicomorphine (10mg/ml) 1ml >30 mins apart increased by 0.5ml every 3 hours if no analgesia

62% followed for 2 days

The evidence

Myocardial infarction: morphine, pethidine and nicomorphine were equally analgesic.

Clinical bottom line (level 2b-)

  1. In patients with chest pain secondary to myocardial infarction, morphine, pethidine and nicomorphine were equally effective.
Nielsen et al: Acta Medica Scandinavia 1984; 215: 349-354
Expires January 2004

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: university hospital in Denmark

275 patients (aged mean 62y (SD 11y), 72% male) acute myocardial infarction admitted to cardiac care unit

Excluded if
  • slurred consciousness
  • cardiovascular compromise (shock, HR<35)
  • severe lung disease
  • allergy to analgesics


    • Control Group: (n = 90, 53 analysed): morphine (10mg/ml) given 1ml > 30 mins apart, with dose increasing by 0.5ml every 3 hours if no analgesia
    Experimental Group: (n = 92, 66 analysed): pethidine (75mg/ml) given 1ml >30 mins apart, does increase by 0.5ml every 3 hours if no analgesia
    Comparison Group: (n = 93, 51 analysed): nicomorphine (10mg/ml) 1ml >30 mins apart increased by 0.5ml every 3 hours if no analgesia

    62% followed for 2 days

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    overall mean volumes of analgesic morphine = 4.6ml; nicomorphine = 4.9ml
    ()     		pethidine = 5.3ml
    ()
    ( to )
    mean volumes of analgesic in AMI patients 4.6
    (3.9)     		5.4
    (4.1)     		-0.8
    (-2.3 to 0.67)

  • Side effects are claimed to be non-significantly different between the groups.

    • Comments

    1. Lack of publication of data for the whole group (including non-MI patients) limits the precision of the study.
    2. Study too small to show differences between analgesics, and follow-up poor.

    Citation

    1. Nielsen JR, Pedersen KE, Dahlstrom CG, et al: Analgetic treatment in acute myocardial infarction. Acta Medica Scandinavia 1984; 215: 349-354
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient chest pain from acute myocardial infarction
    Intervention or Exposure use of morphine, nicomorphine or pethidine
    Outcome pain relief and side effects
Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
overall mean volumes of analgesic morphine = 4.6ml; nicomorphine = 4.9ml
() 		pethidine = 5.3ml
()
( to )
mean volumes of analgesic in AMI patients 4.6
(3.9) 		5.4
(4.1) 		-0.8
(-2.3 to 0.67)

Side effects are claimed to be non-significantly different between the groups.

Comments

  1. Lack of publication of data for the whole group (including non-MI patients) limits the precision of the study.
  2. Study too small to show differences between analgesics, and follow-up poor.

Citation

  1. Nielsen JR, Pedersen KE, Dahlstrom CG, et al: Analgetic treatment in acute myocardial infarction. Acta Medica Scandinavia 1984; 215: 349-354
Contributor: Bob Phillips and Clare Wotton, November 1999
Reviewer:

Clinical Question.
Patient chest pain from acute myocardial infarction
Intervention or Exposure use of morphine, nicomorphine or pethidine
Outcome pain relief and side effects