Authors: Rob Hirst, Andy Neill, Dave McCreary, Chris Connolly, Becky Maxwell / Codes: / Published: 01/11/2022
Authors
– Andy neill
– Dave Mccreary
Clinical Question
– Does IV paracetamol actually do much?
Paper title
– Intravenous acetaminophen does not reduce morphine use for pain relief in emergency department patients: A multicenter, randomized, doubleblind, placebocontrolled trial
Author
– Minotti et al AEM 2022
Background
– IV paracetamol has become fairly ubiquitous in the UK and Ireland I think. Its never been the most evidence based intervention and I think we often use it to justify our existence, ie we give a drip of something just so that the patient gets something they could otherwise buy in tesco. There is a bunch of RCT data out there but this trial in particular looked to see if it reduced morphine requirements and by extrapolation was it having a signficant analgesic effect
Methods
– multicentre placebo trial in 2 EDs switzerland. Lots of good EBM points in this trial
– day time hours recruitment which makes it more of a convenience sample but is pain really that different after midnight.
– pain 4 or more (which is quite a lot bar)
– excluded if pain relief in the preceding 6 hrs
– got morphine 0.1mg/kg (very standard) plus 1g paracetamol IV or a placebo IV
– pain measured every 15 mins following this, got additional morphine if pain still >4 every 15 mins
– primary outcome of morphine used
Results
– 200 patients, mostly tummy and flank pain with some extremity pain too.
– ~12mg morphine in each group to achieve pain relief
Thoughts
– well done study
– hard to argue for any great benfit for paracetamol here when you’re already getting moprhine.
– in reality we often use it to avoid giving an opiate (often for logistics like doctor administration or needing a trolley)
– for those who don’t need an opiate then it may well still have a role but if the gut is working then maybe just give PO?
- Trans101: Avoiding a Trans Emergency – Ethan Wilson
- Notifiable Diseases – Ines Corcuera Hotz and Grace George
- Local Anaesthetics – Graham Gardner