Background : Our aim was to compare the efficacy and safety of nebulized morphine to a placebo in abdominal pain requiring a
surgeon’s advice.
Methods : In a prospective, randomized, controlled and double-blind study, we included 100 patients with abdominal pain. They
were assigned to 2 groups: a nebulized morphine group which received a maximum of 3 nebulizations of 10-mg morphine every
10 minutes, and a placebo group which received 3 nebulizations of normal saline serum until pain relief. The visual analog scale was
monitored at baseline, 10, 20, 30, 45 and 60 minutes after the start of drug administration. Treatment success was defined by the
percentage of patients in whom visual analog scale decreased by a rate equivalent to or greater than50% of its baseline value. When
this end point was not reached, rescue morphine was administered. Pain resolution time was defined by the elapsed time between the
start of the protocol and reaching treatment success criteria. The secondary endpoints were the appearance of side effects, delay of a
possible surgical intervention, complication of a pathology or are-consultation.
Results : The lowest resolution time was observed in the nebulized morphine group (mean = 38.4 ± 16 min), compared to the
placebo group (mean= 53.1 ± 14 min) (p <0.001). Side effects were minor and comparable in the two groups. The average delay of
the opinion of the surgeon in the 2 groups is comparable with 1.56 hours in the nebulized morphine group and 1.44 hours in the
placebo group(p = 0.310).
The surgeon’s assessment of the diagnosis was easier in the nebulized morphine group, but not significantly (p = 0.07). Nebulized
morphine significantly improved the patient’s satisfaction (p <0.001). The delays of the surgical procedure were comparable in both
groups with an average of 9.94 hours in the nebulized morphine group, and 9.06 hours in the placebo group. No complications were
noted in neither of the groups at 30 days.