A survey of opioid administration in an emergency department

This study aimed to document patterns of opioid use in an emergency department, and determine factors which influenced choice of opioid. A survey of opioid administrations was conducted over a two month period in the Emergency Department at Flinders Medical Centre. Opioids were administered in 476 presentations by 456 different patients, representing 5.7% of total presentations during the survey period. Morphine and pethidine were the most frequently used opioids. Morphine was used more commonly for chest pain not associated with injury and for pulmonary oedema. Pethidine was more frequently used for pain due to injury, abdominal pain, biliary colic or cholecystitis. Morphine was given mainly by the intravenous route whereas pethidine was usually given intramuscularly. The most frequent reason for choosing a particular opioid was familiarity. Patients who expressed a preference for a particular opioid usually preferred pethidine, consistent with anecdotal reports. Patterns of opioid use were affected by real or perceived differences in pharmacological activities within this class of drugs. However, the major influences were tradition and familiarity. 1993 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine