Intravenous Acetaminophen and Morphine Versus Intravenous Morphine Alone for Acute Pain in the Emergency Department

Intravenous Acetaminophen and Morphine Versus Intravenous Morphine Alone for Acute Pain in the Emergency Department: a Multicenter Randomized Controlled Double-blind Non-inferiority Trial

In emergency medicine, acute pain is a common reason for consultation. It is recommended that patients in moderate to severe pain should receive a combination of intravenous acetaminophen and morphine. However, the data are sparse to support this strategy. Thus, the purpose of our research is to test non-inferiority of IV morphine alone versus IV acetaminophen and morphine in a multicenter, randomized, controlled double blind trial in ED patients with moderate to severe acute pain.

This study is designed to assess whether IV morphine alone is non inferior to combination IV acetaminophen and morphine for the management of moderate to severe pain in the ED. Numeric rating scale pain score will be compared between those who receive morphine alone and who will receive acetaminophen and morphine at 15, 30, 45 and 60 min post first injection.

Inclusion Criteria:

• 18 Years and older
• Moderate to severe acute pain, defined as a numeric rating scale score greater than or equal to 5.
• Conscious patient
• Clinical stability at the physician's discretion
• Patient able to talk and give a verbal assessment of his/her pain with the numerical verbal scale
• Out of guardianship and/or tutorship
• Affiliated to the social security plan.

Exclusion Criteria:

• Pregnancy and Breast-feeding
• Patient Unable to give numeric rating scale scores
• Patient with a weight strictly less than 50kg.
• acute pulmonary edema, acute respiratory failure
• Acute coronary syndrome or unbalanced ischemic heart disease in progress.
• Acute alcoholic intoxication.
• Patient who received morphine, or acetaminophen, or analgesic, or anti-inflammatory, for the current acute pain episode, within 8 hours prior to arrival at the emergencies
• No possibility of having venous access
• History of chronic pain during treatment.
• Allergy, intolerance or know contraindication to paracetamol or morphine or to an excipient.
• Renal or hepatic insufficiency.
• Association with buprenorphine, nalbuphine and pentazocine.
• Patient unable or unable to give written consent.