Emerg Med J doi:10.1136/emj.2010.104687
  • Original article

Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department

  1. Jonathan Benger1,2
  1. 1Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
  1. Correspondence to Dr Richard Jeavons, Academic Department of Emergency Care, University Hospitals Bristol NHS Marlborough Street, Bristol BS2 8HW, UK; richard.jeavons{at}
  • Accepted 18 November 2010
  • Published Online First 1 March 2011


Objective To compare the clinical effectiveness of intravenous paracetamol with intravenous morphine in patients with moderate to severe traumatic limb pain.

Methods 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.

Results 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.

Conclusion Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine in isolated limb trauma. Further larger studies are required.


  • Funding An independent grant was obtained from the College of Emergency Medicine.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the NHS ethics committee. RED reference number 07/H0106/118.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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