Intravenous Acetaminophen for Renal Colic in the Emergency Department: Where Do We Stand?

Sin, Billy; Koop, Kimberly; Liu, Michelle; Yeh, Jun-Yen; Thandi, Pardeep

doi:10.1097/mjt.0000000000000526

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…In the era of increasing opioid use, this benefit could have a significant clinical and public health relevance that should be carefully considered. Our study showed that tramadol is superior to acetaminophen in decreasing pain intensity and the need for rescue morphine treatment, suggesting the weak opioid‐sparing effects of acetaminophen alone as concluded by recent meta‐analysis . Indeed, in the past 2 decades, evidence‐based multimodal opiate‐sparing analgesia has become increasingly widespread in different clinical settings.…”

Section: Discussionsupporting

confidence: 60%

“…Our study showed that tramadol is superior to acetaminophen in decreasing pain intensity and the need for rescue morphine treatment, suggesting the weak opioid-sparing effects of acetaminophen alone as concluded by recent meta-analysis. 24,25 Indeed, in the past 2 decades, evidence-based multimodal opiatesparing analgesia has become increasingly widespread in different clinical settings. The concept is to combine drugs from different classes to provide a better analgesia at reduced doses of individual agents with an opiatesparing effect.…”

Section: Discussionmentioning

confidence: 99%

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Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

et al. 2019

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Objectives To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain. Methods This is a single‐blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30. Results We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04). Conclusion Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

et al. 2019

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“…Since 2015, the research program produced 14 peer-reviewed publications. All publications were based on pharmacy practice or use of pharmacotherapy, which included 7 case reports (50%), 31 -39 4 structured evidence-based reviews (28.5%), 38 -41 1 original prospective randomized double-blind, placebo-controlled trial (7.1%), 42 one meta-analysis (7.1%), 43 and 1 original retrospective cohort study (7.1%). 30 Six pharmacy residents from 5 different classes and 7 pharmacy students were first, second, or third authors on the publications.…”

Section: Resultsmentioning

confidence: 99%

Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

Sin

Ciaramella

Stein

et al. 2019

Journal of Pharmacy Practice

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Study Objective The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). Methods Data from January 2015 to August 2017 extracted from the department of pharmacy’s electronic documentation system and the hospital’s electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution’s administration as an acceptable reflection of the impact for activity. Results The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. Conclusion We created and implemented an advanced practice model tailored to our institution’s needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.

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“…To compare the IV-PC with morphine for the management of acute renal colic pain, Bektas et al conducted a doubleblind, placebo-controlled clinical trial and showed that the efficacy of both IV-PC and morphine was similar (12). In a systematic review and meta-analysis by Sin et al, the safety, efficacy, cost-benefits and opioid-sparing effects of IV-PC in patients with renal colic were determined and demonstrated that IV-PC was weaker in the pain reduction than opioids or nonsteroidal anti-inflammatory drugs (20). Additionally, different studies evaluated the side effects of PC versus KET following different procedures.…”

Section: Discussionmentioning

confidence: 99%

Intravenous paracetamol versus ketorolac for pain attenuation in patients with renal colic; a randomized, single blind and controlled clinical trial

et al. 2020

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Introduction: Pain control is an essential care for patients with renal colic in emergency wards. Objectives: This study aimed to compare the analgesic efficacy of intravenous (IV) paracetamol (PC) versus ketorolac (KET) for patients with renal colic. Patients and Methods: In a randomized controlled clinical trial, 110 patients with renal colic referred to the emergency department of Kosar hospital, Semnan between October 2015 and June 2016 were selected. Eighty-eight patients were divided into two groups (44 patients in each group) of PC (1 g/IV) and KET (30 mg/IV). One patient in each group was excluded during the study. Vital signs and pain severity (measured by visual analogue scale [VAS]) of all patients were recorded at admission time 0, 20, 40 and 60 minutes after treatment. Then, the results were compared in two groups. Results: The results showed that at the time of 0, 20, 40 and 60 minutes after the administration of the PC and KET drugs, no significant difference was seen in severity of pain based on VAS score between the two groups (P<0.05). Moreover, there were no significant differences in the vital signs of two groups (P<0.05). No adverse effects were reported in each group. Conclusion: In conclusion, the use of IV-PC and KET in patients with renal colic had similar pain relieving effects without any adverse effects.

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Intravenous Acetaminophen for Renal Colic in the Emergency Department: Where Do We Stand?

Cited by 14 publications

References 26 publications

Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain

Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

Intravenous paracetamol versus ketorolac for pain attenuation in patients with renal colic; a randomized, single blind and controlled clinical trial

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