Objective To determine if intravenous paracetamol was superior to oral paracetamol as an adjunct to opioids in the management of moderate to severe pain in the ED setting.
Methods A prospective, randomised, double-blind, double-dummy, controlled trial was conducted at a single academic tertiary care ED. Adult patients with moderate to severe pain were randomly assigned to receive either the intravenous paracetamol or oral paracetamol. The primary outcome was Visual Analogue Scale (VAS) pain reduction at 30 min. A clinically significant change in pain was defined as 13 mm.
Results 87 participants were included in the final analysis, with a median age of 43.5 years and 59.8% were female. Overall mean baseline VAS pain score was 67.9 mm (±16.0). Both formulations achieved a clinically significant mean pain score reduction at 30 min, with no significant difference between the groups with 16.0 mm (SD 19.1 mm) in the intravenous group and 14.6 mm (SD 26.4) in the oral group; difference −1.4 mm (95% CI −11.6 to 8.8, P=0.79). Secondary outcomes, including postintervention intravenous opioid administration, patient satisfaction, side effects and length of stay, did not differ between groups.
Conclusions Overall, there was a small but clinically significant decrease in pain in each group. No superiority was demonstrated in this trial with intravenous paracetamol compared with oral paracetamol in terms of efficacy of analgesia and no difference in length of stay, patient satisfaction, need for rescue analgesia or side effects.
- pain management
- analgesia/pain control
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Presented at the Australasian College for Emergency Medicine, Annual Scientific Meeting, Queenstown, New Zealand, November 2016.
Contributors JF, DL and RR conceived the study and designed the protocol and funding application and conduct of the trial. BC assisted with funding application. VNV assisted with statistical design and analysis. KL, MF and KR assisted with design and study conduct including patient recruitment. JF was responsible for drafting the manuscript; all authors contributed to revisions and approve the final manuscript. JF takes responsibility for the work.
Funding Supported by grants from James Cook University and the Emergency Medicine Foundation. Grant number: EMPJ-107R22-2014EMPJ-107R22-2014.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Townsville Hospital and Health Service Human Research Ethics Committee (HREC/14/QTHS/151).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Study data will be made available from the corresponding author on request.
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