Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparing the Effect of Intravenous Acetaminophen (Apotel®) and Intravenous Morphine in Controlling the Pain of Forearm and Leg Fractures in Adults

Document Type : Original Article (s)

Authors
Marzieh Mollaei 1
Mehrdad Esmailian 2
Farhad Heydari 2
1 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: This study evaluated the analgesic and safety effects of intravenous acetaminophen versus intravenous morphine in management of pain in forearm and leg fractures.Methods: This study was a randomized double-blind clinical trial conducted on patients (15-60 years-old) with forearm and leg fracture and moderate to severe pain (pain score of 4 or more). Patients were randomized in to two groups, then, 1 g of intravenous acetaminophen or 0.1 mg/kg morphine was infused in 100 ml normal saline to either acetaminophen or morphine group. The pain severity was measured by Numeric Rating scale on arrival and 30 minutes after drug administration. The adverse reactions were also recorded.Findings: 55 patients were entered. There was no significant difference in analgesic effect between the Intravenous Acetaminophen and morphine groups (P = 0.140), but, there was a significant difference in side effects between the two groups. (P = 0.014).Conclusion: Intravenous acetaminophen appears to provide a similar level of analgesic comparable to intravenous morphine in limb fracture, however, further larger studies are required.
Keywords
Acetaminophen
Morphine
Pain management
Emergency Department
  1. Ferrell BR, Pasero Ch, McCaffery M. Pain assessment and pharmacologic management. 1st ed. Philadelphia, PA: Mosby; 2010.
  2. Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs 2011; 12(3): 118-45.
  3. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: New vistas of an old drug. CNS Drug Rev 2006; 12(3-4): 250-75.
  4. Malaise O, Bruyere O, Reginster JY. Intravenous paracetamol: A review of efficacy and safety in therapeutic use. Future Neurology 2007; 2(6): 673-88.
  5. Svensson CI, Yaksh TL. The spinal phospholipase-cyclooxygenase-prostanoid cascade in nociceptive processing. Annu Rev Pharmacol Toxicol 2002; 42: 553-83.
  6. Wilgus TA, Ross MS, Parrett ML, Oberyszyn TM. Topical application of a selective cyclooxygenase inhibitor suppresses UVB mediated cutaneous inflammation. Prostaglandins Other Lipid Mediat 2000; 62(4): 367-84.
  7. Gregoire N, Hovsepian L, Gualano V, Evene E, Dufour G, Gendron A. Safety and pharmacokinetics of paracetamol following intravenous administration of 5 g during the first 24 h with a 2-g starting dose. Clin Pharmacol Ther 2007; 81(3): 401-5.
  8. Benson GD, Koff RS, Tolman KG. The therapeutic use of acetaminophen in patients with liver disease. Am J Ther 2005; 12(2): 133-41.
  9. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 2005; 102(4): 822-31.
  10. Dejonckheere M, Desjeux L, Deneu S, Ewalenko P. Intravenous tramadol compared to propacetamol for postoperative analgesia following thyroidectomy. Acta Anaesthesiol Belg 2001; 52(1): 29-33.
  11. Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, Perez-Flores D. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg 2001; 92(6): 1473-6.
  12. Masoumi K, Forouzan A, Asgari DA, Feli M, Barzegari H, Khavanin A. Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double-blind, controlled trial. Emerg Med Int 2014; 2014: 571326.
  13. Azizkhani R, Pourafzali SM, Baloochestani E, Masoumi B. Comparing the analgesic effect of intravenous acetaminophen and morphine on patients with renal colic pain referring to the emergency department: A randomized controlled trial. J Res Med Sci 2013; 18(9): 772-6.
  14. Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CH. Intravenous paracetamol versus morphine for renal colic in the emergency department: A randomised double-blind controlled trial. Emerg Med J 2012; 29(11): 902-5.
  15. Esmailian M, Moshiri R, Zamani M. Comparison of the analgesic effect of intravenous acetaminophen and morphine sulfate in rib fracture; A randomized double-blind clinical trial. Emerg (Tehran) 2015; 3(3): 99-102.
  16. Khan ZU, Iqbal J, Saleh H, El Deek AM. Intravenous Paracetamol is as effective as Morphine in Knee Arthroscopic day surgery procedures. Pak J Med Sci 2007; 23(6): 851-3.
  17. Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emerg Med J 2012; 29(1): 37-9.
Journal of Isfahan Medical School
Volume 34, Issue 376 - Serial Number 376
January and February 2016
Pages 293-298

  • Receive Date 09 August 2015
  • Accept Date 06 April 2022