Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis Isma Qureshi ,1 Khadiga Abdulrashid ,2,3 Stephen H Thomas,1,4 Manar E Abdel-Rahman ,2 Sameer A Pathan,1,4,5 Tim Harris1,4

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Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs( NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis

Isma Qureshi ,1 Khadiga Abdulrashid ,2,3 Stephen H Thomas,1,4 Manar E Abdel-Rahman ,2 Sameer A Pathan,1,4,5 Tim Harris1,4

 

Findings

  • Iv Paracetamol is as effective as iv opioids and iv/im NSAIDs in delivering pain relief at thirty and sixty minutes after administration
  • Adverse events are rarer then with administration of iv opioids
  • However, rescue analgesia is more frequently required then after NSAIDs at T30
  • same amount of rescue medication required then after iv opioids

Bottom line

  • First line medication is iv/im NSAIDs and Paracetamol iv is adequate alternative if NSAIDS are contraindicated
  • Iv Paracetamol is a great alternative to iv opioids for patients in high -risk areas (off stretcher)

What is this paper about

  • Comparing three main different modes of iv analgesia in their effectiveness and safety when administered isolated
  • Pain levels were measured at T30,60 and 120 via numerical or visual pain scale
  • Rescue analgesia and adverse events were compared

Study design

  • Systematic review and metanalysis of 24 randomized control studies investigating the above
  • Exclusion criteria for studies:
  1. Oral paracetamol
  2. Lignocaine and ice
  3. Prodrugs
  4. Im Paracetamol
  5. Comparator Metoclopramide
  • Different types of pain modalities included into trial

 

Conclusion:

If oral Paracetamol has not been yet used, Iv paracetamol can be used safely and with equal effect to im/iv Nsaids and iv Opioids in effective pain management in high risk areas such as the off stretcher area in an highly busy Emergency Department.