Jalili Mohammad, Mozaffarpour Noori Ali, Sedaghat Mojtaba, Safaie Arash
Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, IR Iran.
Department of Emergency Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran.
Trauma Mon. 2016 Feb 6;21(1):e19649. doi: 10.5812/traumamon.19649. eCollection 2016 Feb.
Efficient pain management is one of the most important components of care in the field of emergency medicine.
This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma.
In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded.
Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05).
Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required.
有效的疼痛管理是急诊医学领域护理中最重要的组成部分之一。
本研究旨在比较静脉注射对乙酰氨基酚和静脉注射硫酸吗啡在减轻肢体创伤患者急性疼痛方面的效果。
在一项随机双盲临床试验中，招募了所有在急诊科患有急性肢体创伤且疼痛评分大于3/10的18岁及以上患者；他们在15分钟内接受了1克静脉注射对乙酰氨基酚或0.1毫克/千克静脉注射硫酸吗啡。主要结局是在开始给药后0、15和30分钟时用数字评分量表测量的疼痛评分。还记录了急救镇痛的需求和不良反应的发生频率。
60名患者随机接受静脉注射对乙酰氨基酚（n = 30）或静脉注射吗啡（n = 30）。对乙酰氨基酚组在30分钟时数字评分量表疼痛强度评分的平均降低值为3.86（±1.61），吗啡组为2.16（±1.39）。然而，与吗啡组相比，对乙酰氨基酚组的疼痛缓解明显更高（P < 0.001）。对乙酰氨基酚组有4名患者和吗啡组有15名患者需要急救镇痛，差异具有统计学意义（P = 0.05）。
在急性肢体创伤中，静脉注射对乙酰氨基酚似乎比静脉注射吗啡提供更好的镇痛效果。需要进一步开展更大规模的研究。
