Methodology: 3.5/5
Usefulness: 2/5

Nasr Isfahani M, et al. BMC Emerg Med. 2024 Jan 25;24(1):15. 

Question and Methods: This triple blinded RCT of 158 patients with isolated closed limb fractures assessed pain scores at 1-hour following the administration of intravenous acetaminophen, acetaminophen plus ibuprofen, or morphine.
Findings: The study findings demonstrate that parenteral ibuprofen in combination with acetaminophen was more effective than morphine 1-hour after administration, with prolonged and sustained analgesia.
Limitations: This study was conducted in Iran in a specific subset of patients with isolated limb fractures and limited comorbidities, with pain assessments limited to 1-hour after administration of medication. Additionally, parenteral acetaminophen and ibuprofen are not routinely used in our emergency department.

Interpretation: While this paper suggests a role for intravenous acetaminophen and ibuprofen for acute fractures, the lack of availability of such agents in Canada limits the usefulness.

Dr. Imane Foudil-Bey

JC Supervisor: Dr. Ian Stiell