Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department

Craig, Michelle; Jeavons, Richard; Probert, Joanne; Benger, Jonathan

doi:10.1136/emj.2010.104687

Cited by 93 publications

(80 citation statements)

References 9 publications

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“…Results of the similar studies did not show any significant difference in the analgesic effect of intravenous acetaminophen and morphine (3)(4)(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 81%

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Intravenous Acetaminophen Versus Intravenous Morphine Sulfate for Isolated Diaphyseal Long Bone Fractures: A Randomized Clinical Trial

Deloee¹,

Zarmehri²,

Pishbin³

et al. 2017

Trauma Mon

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Objectives: Pain management is an important issue in traumatic patients. The aim of this randomized clinical trial was to compare the analgesic effect of intravenous acetaminophen with intravenous morphine sulfate in patients with traumatic diaphyseal long bone fracture. Methods: This double-blind randomized clinical trial was carried out in an academic trauma center in Mashhad, Iran, from February to October 2013. After primary modalities like limb elevation, ice and limb splinting, patients were allocated to receive either acetaminophen 15 mg/kg or morphine sulfate 0.1 mg/kg randomly. The pain severity was measured using a visual analogue scale before drug administration and 5 and 30 minutes after drug administration. Then, the results were compared. Results: Of the 50 patients recruited over 9 months 26 patients received intravenous morphine sulfate and 24 patients received intravenous acetaminophen. A significant difference was observed between the two groups at 5 minutes after drug administration; the morphine sulfate group showed more reduction in pain severity after 5 minutes (P < 0.0001). However, there was no significant difference in pain severity at 30 minutes after drug administration between the two groups (P = 0.85). Conclusions: It seems that after 30 minutes, intravenous acetaminophen is as effective as intravenous morphine sulfate in pain management of isolated diaphyseal long bone fracture. However, it should be noted that the analgesic effect of acetaminophen begins with a delay. Thus, we suggest using intravenous acetaminophen when morphine administration is contraindicated.

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“…Results of the similar studies did not show any significant difference in the analgesic effect of intravenous acetaminophen and morphine (3)(4)(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 81%

“…A single-blind emergency department study over patients presenting with renal colic found that intravenous acetaminophen was equally effective as intravenous morphine (3). There are also some other studies showing that intravenous acetaminophen is as effective as intravenous morphine in pain management (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Intravenous Acetaminophen Versus Intravenous Morphine Sulfate for Isolated Diaphyseal Long Bone Fractures: A Randomized Clinical Trial

Deloee¹,

Zarmehri²,

Pishbin³

et al. 2017

Trauma Mon

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“…19 Intravenous paracetamol 1 gram has analgesic activity in moderate to severe post-operative pain similar have shown ketorolac 30 milligram 20 diclofenac 75 miligram, 21 morphine 10 miligram. 22 It also demonstrated that Intravenous paracetamol reduce the use of opioid. It reduces the need for the patient's total opioid by 24-46% and increase in patient satisfaction.…”

Section: Discussionmentioning

confidence: 98%

Study of Preemptive Ana L Gesic Effects of Intravenous Paracetamol in Reducing Doses of Morphine in Patients Undergoing Laparoscopic Cholecystectomy

Khan¹,

Sofi²,

Munshi³

et al. 2015

jemds

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ABSTRACT:Paracetamol is primarily thought to be a cyclo-oxygenase inhibitor acting through central nervous system. Indirect effects of paracetamol are through serotonergic system as a nonopioid analgesic. We studied intravenous paracetamol 1 gram preoperatively to assess its intraoperative and post-operative analgesic effects, in reducing intraoperative morphine requirements, to reduce the requirement of postoperative analgesia, enable early recovery from anaesthesia and to reduce postoperative nausea and vomiting. One hundred patients from either sex classified in ASA Class I and II scheduled for laparoscopic cholecystectomy were randomly allocated into two groups of 50 patients each. Group I (Study group) received paracetamol 1 gram infusion prior to induction with 50µg/kg morphine diluted with normal saline to a total volume of 5ml. Group II (Control group) received l00µg/kg morphine diluted with normal saline to a total volume of 10ml at induction. We observed that there was significant increase in mean time for rescue analgesia from induction of anaesthesia in Group I (study group) was 11.25±1.827 hours and Group II (Control group) was 6.98±4.568 hours (p value < 0.001). The median value of visual analogue score was lower at all-time points in group I when compared to group II at each interval and it was statistically significant (p value < 0.001). A significant decrease in mean number of administered doses of rescue analgesia during 24 hours was seen in the study group (0.52±0.505) as compared to the control group (1.3±0.463) with a p value of < 0.001. Mean modified Aldrete score in the study group was 9.78±0.465 and in control group it was 8.1±1.15. It was statistically significant p value of <0.001. The mean number episodes of nausea and vomiting in group I were 0.74±0.633 and in group II 0.94±0.652 and was statistically insignificant with p value of 0.361. CONCLUSION: Administration of intravenous paracetamol and 50% doses of morphine prior to induction in patients undergoing laparoscopic cholecystectomy ensures effective analgesic intra-operatively as well as postoperatively and was associated with earlier discharge from post anaesthetic care unit when compared with full doses of IV morphine, however above combination was not able to decrease significantly reduction in morphine related adverse effects in these patients.

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“…Intravenous acetaminophen is being studied for acute pain such as in acute traumatic limb injuries [45] or rib fractures [46] or in postoperative patients [47,48]. It has also been shown to reduce the need for rescue pain medications such as opioids [49,50].…”

Section: Acetaminophenmentioning

confidence: 99%

Acute Pain Management in the Emergency Department

Samcam¹,

Papa²

2016

Pain Management

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The most common presenting complaint to the emergency department (emergency room) is pain. Unfortunately, pain is still undertreated in this setting. Literature has shown that treatment of pain not only improves patient satisfaction but also improves mood, decreases length of hospital stay, and decreases mortality. Various pharmacological options are available for treating acute pain, ranging from oral, intravenous, and intramuscular medications; topical agents; and peripheral nerve blocks. Objectively assessing and documenting a patient's pain is the key to determining treatment. The approach to a patient with acute pain requires an experienced clinician who is aware of the pharmacology of analgesics and anesthetics, contraindications, precautions, side effects, administration methods, and monitoring requirements.This chapter briefly covers the pathophysiology of acute pain and the different treatment modalities available to the emergency physician.

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Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department

Abstract: Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine in isolated limb trauma. Further larger studies are required.

Cited by 93 publications

References 9 publications

Intravenous Acetaminophen Versus Intravenous Morphine Sulfate for Isolated Diaphyseal Long Bone Fractures: A Randomized Clinical Trial

Intravenous Acetaminophen Versus Intravenous Morphine Sulfate for Isolated Diaphyseal Long Bone Fractures: A Randomized Clinical Trial

Study of Preemptive Ana L Gesic Effects of Intravenous Paracetamol in Reducing Doses of Morphine in Patients Undergoing Laparoscopic Cholecystectomy

Acute Pain Management in the Emergency Department

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