Paracetamol or nonsteroidal anti‐inflammatory drugs or combination of both analgesics in acute post‐trauma pain: a randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Paracetamol or nonsteroidal anti‐inflammatory drugs or combination of both analgesics in acute post‐trauma pain: a randomized controlled trial Via Wiley: Academic Emergency Medicine: Table of Contents Abstract Objectives Non‐steroidal anti‐inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve post‐trauma pain in the emergency department. However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining a NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of post‐traumatic pain of the extremity after discharge from the emergency department (ED). Methods This is a prospective, randomized controlled trial, carried out in a single ED from March 2017 to November 2018. The included patients were randomly assigned to receive paracetamol alone, or high‐dose NSAID (piroxicam) alone, or a combination of paracetamol and high‐dose NSAID for 7 days after ED discharge. The primary outcome was need for additional oral analgesics. Secondary outcomes included the change of the visual numeric scale (VNS) between ED discharge (VNS D0) and 7 days later (VNS D7), ED revisits for residual pain, side effects and patient satisfaction as assessed by a Likert satisfaction scale. Results The need for additional oral analgesics were comparable between paracetamol‐NSAID combination group (9.8%) and paracetamol group (11.4%) (p=0.43). ED readmission rate was also comparable between the two groups at 5.6% and 5.8% respectively (p=0.86). In contrast, need for new analgesics and ED revisit rates were both more frequent in the high‐dose NSAID group. Mean VNS decrease on D7 compared to D0 was 66%, 63% and 67%, respectively in paracetamol group, NSAID and paracetamol‐NSAID combination group (p=0.32). Frequency of dissatisfaction was higher in NSAID group. Side effects were more frequent in NSAID and paracetamol‐NSAID combination groups. Conclusion This study found that the combination of a high‐dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high‐dose NSAID alone for post‐traumatic extremity pain. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.