title: Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial.
abstract: 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.
authors: Akdeniz University Medical Faculty, Department of Emergency Medicine, Antalya, Turkey.
authors: Cenker
authors: C
authors: Eken
authors: Mustafa
authors: M
authors: Serinken
authors: Hayri
authors: H
authors: Elicabuk
authors: Emrah
authors: E
authors: Uyanik
authors: Muhammed
authors: M
authors: Erdal
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000208:Acute Disease; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007660:Ketoprofen / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D014325:Tromethamine / Q000008:administration & dosage*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014325:Tromethamine; D000082:Acetaminophen; D009020:Morphine; D007660:Ketoprofen; C118296:dexketoprofen trometamol
keywords: analgesia/pain control; emergency departments; treatment