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

Abstract

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.

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis

“…Included studies’ pain scores ranged from 2.7 to 9.2 (mean 7.6). In 24 trials,9–14 16–30 36–38 the change in pain scores from T0 to T30 was reported, and all trials except one29 reported that all groups (paracetamol, NSAIDs or opioids) achieved clinically significant reductions in pain scores from T0 to T30. Key data were missing from 25 papers, and the lead authors were contacted to request the information,8–32 but no authors replied to requests for data.…”

“…IVP was administered as a single dose of 1 g in 100 mL NS (100 ml normal saline) in 26 trials8–13 15–19 21–30 32 36–38 and at a dose of 15 mg/kg in one trial 20. The infusion rate for the administration of IVP was as a rapid bolus infusion in three trials,11 12 24 slow infusion over 5–20 min in 16 trials,8 10 13 16 18 19 21 22 25 26 29–32 36–38 and not mentioned for 8 trials 9 14 15 17 20 23 27 28. Doses of morphine were 0.1 mg/kg in 12 trials,9 13 19–23 25–28 37 5 mg/mL in 1 trial30 and 10 mg in 2 trials 18 31…”

“…The infusion rate for the administration of IVP was as a rapid bolus infusion in three trials,11 12 24 slow infusion over 5–20 min in 16 trials,8 10 13 16 18 19 21 22 25 26 29–32 36–38 and not mentioned for 8 trials 9 14 15 17 20 23 27 28. Doses of morphine were 0.1 mg/kg in 12 trials,9 13 19–23 25–28 37 5 mg/mL in 1 trial30 and 10 mg in 2 trials 18 31…”

“…After full analysis, 13 trials were excluded (figure 1). Key data were missing from 25 papers, and the lead authors were contacted to request the information 8–32…”

Acupressure has not an analgesic effect in patients with renal colic: a randomized controlled trial

“…As a result, there is currently a greater tendency towards the use of nonsteroidal antiinflammatory drugs (NSAIDs). (5)(6)(7)(8) On the other hand, NSAIDs have complications as gastrointestinal bleeding and renal failure. (9) According to aforementioned complications, it is necessary to use less complicated and more effective medications for RC.…”