In Combat Amputees with TBI, Early Morphine Administration Reduces Psychiatric Sequelae

Joel Yager, MD

Intravenous morphine, with or without fentanyl, but not fentanyl alone, lowers the risk for PTSD and depression.

Rates of post-traumatic stress disorder (PTSD) after traumatic injury vary widely. Administering morphine soon after combat injury reportedly reduces PTSD rates by about 50%. Using several military databases, investigators retrospectively examined PTSD and other psychiatric disorders among 258 Iraq combat veterans who required limb amputation (typically lower limbs injured in blasts); 115 (45%) incurred a traumatic brain injury (TBI; rated as severe to moderate in 20).

The sample included 145 patients with medication records from resuscitation and hemorrhage control efforts before the patients were transferred to field hospitals for surgery. Among those with TBI who received intravenous morphine (either with or without fentanyl) in this early period, subsequent rates of PTSD and mood disorders were 6% and 16%. Among those who received only fentanyl, rates were 41% and 47%, respectively. No analgesia-related differences occurred in patients without TBI (around 20% for PTSD or depression). Early administration of any morphine versus fentanyl alone was not associated with differences in later rates of adjustment disorders, anxiety, substance abuse, or other mental health disorders.

Citation(s):

Melcer T et al. Glasgow Coma scores, early opioids, and posttraumatic stress disorder among combat amputees. J Trauma Stress 2014 Mar 25; [e-pub ahead of print].