Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Emerg Med J. 2012 Jan;29(1):37-9. doi: 10.1136/emj.2010.104687. Epub 2011 Mar 1.
To compare the clinical effectiveness of intravenous paracetamol with intravenous morphine in patients with moderate to severe traumatic limb pain.
This randomised, double-blind pilot study was conducted in an urban UK emergency department. Patients between 16 and 65 years old with isolated limb trauma and in moderate to severe pain (pain score of 7 or more) received either 1 g intravenous paracetamol or 10 mg intravenous morphine sulphate over 15 min. The primary outcome measure was pain score measured on a visual analogue scale at 0, 5, 15, 30 and 60 min after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded.
55 patients were recruited over 10 months. There was no significant difference in analgesic effect between the paracetamol and morphine groups at any time interval. There was no significant difference in the rescue analgesia administered, but there were significantly more adverse reactions in the morphine group.
Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine in isolated limb trauma. Further larger studies are required.
比较静脉注射对乙酰氨基酚与静脉注射吗啡治疗中重度创伤性肢体疼痛的临床疗效。
这是一项在英国城市急诊部门进行的随机、双盲先导研究。纳入年龄在 16 至 65 岁之间、有孤立性肢体创伤且处于中重度疼痛（疼痛评分 7 分或以上）的患者，给予 1 g 静脉注射对乙酰氨基酚或 10 mg 静脉注射硫酸吗啡，输注时间为 15 分钟。主要结局测量指标为给药后 0、5、15、30 和 60 分钟时的视觉模拟评分（VAS）疼痛评分。还记录了需要抢救性镇痛的情况和不良反应的发生频率。
在 10 个月的时间里，共纳入了 55 名患者。在任何时间间隔，对乙酰氨基酚组和吗啡组的镇痛效果均无显著差异。两组接受的抢救性镇痛药物无显著差异，但吗啡组的不良反应发生率显著更高。
在孤立性肢体创伤中，静脉注射对乙酰氨基酚似乎能提供与静脉注射吗啡相当的镇痛效果。需要进一步开展更大规模的研究。
