Oxycodone Versus Codeine for Triage Pain in Children With Suspected Forearm Fracture

Charney, Rachel L.; Yan, Yan; Schootman, Mario; Kennedy, Robert M.; Luhmann, Janet D.

doi:10.1097/pec.0b013e3181850ca3

Cited by 36 publications

(20 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Oral oxycodone was more effective and produced less itching than codeine, but early administration at triage was required as having Xrays, rather than examination or casting, was identified as the most painful period (Charney et al, 2008 Level II).…”

Section: Chapter 10mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

View full text Add to dashboard Cite

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

show abstract

Section: Chapter 10mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…2 The popularity of hydrocodone/acetaminophen postdischarge is supported by two small clinical trials, 3,4 and several other studies that compare the efficacy of commonly prescribed oral opioids in different settings. [5][6][7][8][9] There has been increasing concern about the abuse of oral opioids in patients discharged from the ED. 10,11 The efficacy of hydrocodone versus codeine has not been adequately studied among discharged adult ED patients with acute pain.…”

mentioning

confidence: 99%

Randomized Clinical Trial of Hydrocodone/Acetaminophen Versus Codeine/Acetaminophen in the Treatment of Acute Extremity Pain After Emergency Department Discharge

Chang

Bijur

Munjal

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

ObjectivesThe objective was to test the hypothesis that hydrocodone/acetaminophen (Vicodin [5/500]) provides more efficacious analgesia than codeine/acetaminophen (Tylenol #3 [30/300]) in patients discharged from the emergency department (ED). Both are currently Drug Enforcement Administration (DEA) Schedule III narcotics.MethodsThis was a prospective, randomized, double‐blind, clinical trial of patients with acute extremity pain who were discharged home from the ED, comparing a 3‐day supply of oral hydrocodone/acetaminophen (5 mg/500 mg) to oral codeine/acetaminophen (30 mg/300 mg). Pain was measured on a valid and reproducible verbal numeric rating scale (NRS) ranging from 0 to 10, and patients were contacted by telephone approximately 24 hours after being discharged. The primary outcome was the between‐group difference in improvement in pain at 2 hours following the most recent ingestion of the study drug, relative to the time of phone contact after ED discharge. Secondary outcomes compared side‐effect profiles and patient satisfaction.ResultsThe median time from ED discharge to follow‐up was 26 hours (interquartile range [IQR] = 24 to 39 hours). The mean NRS pain score before the most recent dose of pain medication after ED discharge was 7.6 NRS units for both groups. The mean decrease in pain scores 2 hours after pain medications were taken were 3.9 NRS units in the hydrocodone/acetaminophen group versus 3.5 NRS units in the codeine/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval [CI] = –0.3 to 1.2 NRS units). No differences were found in side effects or patient satisfaction.ConclusionsBoth medications decreased NRS pain scores by approximately 50%. However, the oral hydrocodone/acetaminophen failed to provide clinically or statistically superior pain relief compared to oral codeine/acetaminophen when prescribed to patients discharged from the ED with acute extremity pain. Similarly, there were no clinically or statistically important differences in side‐effect profiles or patient satisfaction. If the DEA reclassifies hydrocodone as a Schedule II narcotic, as recently recommended by its advisory board, our data suggest that the codeine/acetaminophen may be a clinically reasonable Schedule III substitute for hydrocodone/acetaminophen at ED discharge. These findings should be regarded as tentative and require independent validation in similar and other acute pain models.

show abstract

“…4 The group found that 50% of children in the ibuprofen group achieved adequate analgesia, and this was more than codeine (40%) or acetaminophen (36%). 4 In another study, Charney et al 5 randomized 177 children with suspected orthopedic injury to receive either codeine (2 mg/kg) or oxycodone (0.2 mg/kg). Although both groups had significant reductions in pain scores measured every 30 minutes for 3 hours, children who received oxycodone had statistically significant greater reduction in pain scores compared with codeine at all time intervals.…”

Section: Codeinementioning

confidence: 99%

“…Although both groups had significant reductions in pain scores measured every 30 minutes for 3 hours, children who received oxycodone had statistically significant greater reduction in pain scores compared with codeine at all time intervals. 5 Codeine metabolism and genetic polymorphism of CYP2D6 Since codeine has a very low affinity for opioid receptors, its analgesic effect is dependent on its conversion to morphine through the cytochrome P-450 enzyme 2D6 (CYP2D6). 6 CYP2D6 catalyzes the conversion of codeine into morphine.…”

Section: Codeinementioning

confidence: 99%

Pain Management in Children: Part 2 — A Transition from Codeine to Morphine for Moderate to Severe Pain in Children

et al. 2012

View full text Add to dashboard Cite

Oxycodone Versus Codeine for Triage Pain in Children With Suspected Forearm Fracture

Cited by 36 publications

References 38 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Randomized Clinical Trial of Hydrocodone/Acetaminophen Versus Codeine/Acetaminophen in the Treatment of Acute Extremity Pain After Emergency Department Discharge

Pain Management in Children: Part 2 — A Transition from Codeine to Morphine for Moderate to Severe Pain in Children

Contact Info

Product

Resources

About