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. Emergency Medicine Journal 10.1136/emj.2010.104687 PMID 21362724
I confess I have a bias against this stuff. Putting paracetamol in a bottle and charging massive amounts for it is quite the marketing move but I have yet to be convinced. It used to always annoy me when I saw docs prescribing this as some sort of placebo for proper pain meds (ie opiates) beacuse the nurses would hang it and the doc wouldn’t have to go to the patient’s bedside themselves and give it. (in the place I sued to work the docs had to give IV morphine, crazy I know…)
One of the bosses even tried to put a kind of ban on it for being overused and overpriced.
But now there’s stuff coming out to try and point me the other way. Like this trial.
- RCT, blinded, non-pharma funded
- pain >7/10 with isolated limb trauma were eligible
- radomised to 1g IV paracetamol over 15 mins or 10mg IV morphine (a reasonable dose) over 15 mins.
- morphine was rescue for both groups if needed
- outcome was pain on a VAS
- n = 55 so tiny numbers which is the single biggest problem
- paracetamol group had consistently higher pain (about 6mm) but it decreased in the same manner as the morophine group and they were of comparable efficacy
- neither group did that well (pain went from 75 to 55 over an hr) and 1/3 in each group wanted resuce meds
- they state a statistically significant increase in AEs in the morphine group but this was 8 vs 2 pts and they don’t tell us specifically what those AEs were
- more pts were satisfied in the morphine group
They conclude that a large trial is needed to answer this, and it seems that it probably does. This one is two small to change practice over. Especially when it involves something almost 10 times the price.
My bias is that I’ll want morphine when I break my arm, and that remains unchanged for now, but as always I’m willing to be persuaded!
The thing I get concerned with, is that people would read this and feel justified in giving paracetmol as appropriate analgesia and forget the more important part of going back and reassessing and offereing more if they need it
NB EM Lit of Note had a similar post a few weeks back on the same topic. Go read it.