Journal of Surgery and Trauma

en Intravenous Acetaminophen Versus Morphine for Acute Limb Trauma Pain: A Randomized Double‑Blind Clinical Trial طب اورژانس Emergency Medicine پژوهشي Research Abstract Introduction: Acute limb trauma is a frequent emergency department presentation that necessitates effective analgesia. Although intravenous morphine is widely used for moderate-to-severe pain, its adverse effect profile raises concerns. Safer non‑opioid alternatives, such as intravenous acetaminophen, require further evaluation. This study aimed to compare the analgesic efficacy and safety of intravenous acetaminophen versus intravenous morphine in patients presenting to the emergency department with acute limb trauma. Methods: In this randomized, double‑blind, controlled clinical trial, 50 patients with acute limb trauma at Imam Reza Hospital, Birjand, Iran, were randomly assigned to two groups (n = 25 per group) to receive either 1 g of intravenous acetaminophen or 0.1 mg/kg of intravenous morphine. Pain was assessed using the Visual Analog Scale (VAS) at baseline, 5, 15, and 30 minutes post‑treatment. Data were analyzed using Fisher's exact test, independent t-tests, and repeated-measures analysis of variance to evaluate pain reduction and hemodynamic stability over time. Results: Pain scores decreased significantly over time in both groups (P < 0.001). No statistically significant differences in pain intensity or hemodynamic parameters were observed between groups (P > 0.05). However, the incidence of adverse effects was significantly higher in the morphine group compared to the acetaminophen group (36% vs. 4%, P = 0.011), with nausea and vomiting being the most frequent complications in patients receiving morphine. The need for rescue analgesia did not differ significantly (P = 0.778). Conclusion: Intravenous acetaminophen is as effective as intravenous morphine in reducing acute pain from limb trauma within the first 30 minutes of administration. Given its superior safety profile characterized by significantly fewer gastrointestinal side effects and its hemodynamic stability, intravenous acetaminophen serves as a viable and preferred non-opioid alternative for early pain management in the emergency department. Key words: Acetaminophen, Emergencies, Morphine, Pain management Acetaminophen, Emergencies, Morphine, Pain management 0 0 http://jsurgery.bums.ac.ir/browse.php?a_code=A-10-532-2&slc_lang=en&sid=1 farhad hakimzadeh hakimzadehfarhad88@gmail.com 100319475328460013003 0009-0004-8073-6890 Yes Department of Emergency Medicine, School of Medicine, Emam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran.