Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

166 patients, between 18-65 years old and presenting with displaced lower extremity fractures, were randomized to receive either hydrocodone/acetaminophen or titrated IV morphine for the treatment of pain upon entering the emergency department. Outcomes measured include pain (measured by Visual Analog Scale; VAS) following treatment, pain (VAS) before and during skeletal traction, and the incidence of adverse effects. Follow up was conducted at 5, 15, 30, 60 and 120 minutes following the administration of the first dose of analgesic. Results of the study revealed significantly less pain reported in the morphine group compared to the Hydrocodone/Acetaminophen group at 5, 15, and 30 minutes; there were no differences in VAS pain score observed at 60 and 120 minutes. VAS pain during skeletal traction was not compared between groups. There was a significantly higher rate of sedation in the morphine group compared to the Hydrocodone/Acetaminophen group; otherwise, there were no significant differences in the rate of adverse effects between groups.