Emerg Med J doi:10.1136/emermed-2012-201670
  • Original article

Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial

  1. Muhammed Erdal3
  1. 1Akdeniz University Medical Faculty, Department of Emergency Medicine, Antalya, Turkey
  2. 2Pamukkale University Medical Faculty, Department of Emergency Medicine, Denizli, Turkey
  3. 3Etimesgut Military Hospital, Department of Family Medicine, Ankara, Turkey
  1. Correspondence to Professor Mustafa Serinken, Pamukkale University Medical Faculty, Department Emergency Medicine, Denizli, 20020, Turkey; mserinken{at}
  • Received 5 July 2012
  • Revised 6 November 2012
  • Accepted 6 January 2013
  • Published Online First 13 February 2013


Study objective The objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose paracetamol versus dexketoprofen versus morphine in patients presenting with mechanical low back pain (LBP) to the emergency department (ED).

Methods This randomised double-blind study compared the efficacy of intravenous 1 gm paracetamol, 50 mg dexketoprofen and 0.1 mg/kg morphine in patients with acute mechanical LBP. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and after 30 min.

Results A total of 874 patients were eligible for the study, and 137 of them were included in the final analysis: 46 patients from the paracetamol group, 46 patients in the dexketoprofen group and 45 patients in the morphine group. The mean age of study subjects was 31.5±9.5 years, and 60.6% (n=83) of them were men. The median reduction in VAS score at the 30th minute for the paracetamol group was 65 mm (95% CI 58 to 72), 67 mm (95% CI 60 to 73) for the morphine group and 58 mm (95% CI 50 to 64) for the dexketoprophen group. Although morphine was not superior to paracetamol at 30 min (difference: 3.8±4.9 (95% CI −6 to 14), the difference between morphine and dexketoprofen in reducing pain was 11.2±4.7 (95% CI 2 to 21). At least one adverse effect occurred in 8.7% (n=4) of the cases in the paracetamol group, 15.5% (n=7) of the morphine group, and 8.7% (n=4) of the dexketoprophen group (p=0.482).

Conclusions Intravenous paracetamol, dexketoprofen and morphine are not superior to each other for the treatment of mechanical LBP in ED.

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