What Initial Dose of Hydromorphone Is Best?

Too little pain medication is a common problem in emergency medicine, but high opiate doses can result in respiratory depression. These investigators compared the efficacy and safety of two hydromorphone dosing regimens in 334 patients who presented to an emergency department with acute pain. Patients were randomized to an initial dose of 2 mg, versus an initial dose of 1 mg followed by another 1 mg dose 15 minutes later if requested.

In each group, 67% of patients declined additional medication one hour after the initial dose. Adverse events were minor and similar in the two groups.