The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department

Abstract

Objectives: Acetaminophen (APAP) is a mainstay for pain management worldwide. The intravenous (IV) formulation has been widely used in Europe for more than 20 years in adults and children. In the United States, IV APAP obtained full approval from the Food and Drug Administration in 2010. There is emerging literature to suggest the use of IV APAP for pain reduction in the emergency department (ED). This evidence-based review examines the evidence pertaining to the use of IV APAP for acute pain control in the ED.Methods: The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of IV APAP for acute pain in the ED were included. Duplicate articles, unpublished reports, abstracts, review articles, and non-English literature were excluded. The primary outcome of interest in this review was the difference in pain score between IV APAP and active comparator or placebo from baseline to a cutoff time specified in the original trials. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant analgesics consumed by patients who received IV APAP. Methodologic quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria.Results: Fourteen RCTs with various methodologic flaws, which enrolled a total of 1,472 patients, met the inclusion criteria. The level of evidence for the individual trials ranged from very low to moderate. In three of the 14 trials, a significant reduction in pain scores was observed in patients who received IV APAP. The first trial found a significant reduction in mean pain scores when IV APAP was compared to IV morphine at 30 minutes after drug administration (4.7 AE 2.3 vs. 2.9 AE 2.2). In the second trial, patients who received IV APAP reported of lower pain scores (31.7 AE 18 mm, 95% confidence interval [CI] = 8.2 to 25.2 mm) compared to those who received IV morphine (48.3 AE 14.1 mm, 95% CI = 8.2 to 25.2 mm), 15 minutes after drug administration. A third trial found a significant reduction (p = 0.005) in the mean pain scores when IV APAP was compared to intramuscular piroxicam at 90 minutes after drug administration. In the remaining eight trials, pain scores were not statistically different when IV APAP was compared to other pain medications. The incidence of side effects associated with IV APAP was very low. Conclusions

Effect of Combination Therapy of Garcinia kola Seed and Vitamin E in Acetaminophen Induced Hepatotoxicity and Oxidative Stress in Albino Rats

“…It is safe at therapeutic dose but causes liver failure in over dose [6]. It is readily available without prescription, used for antipyretic and analgesic purposes [7]. It is linked to hepato toxicity because of the ability to generate free radicals which might subsequently result to variety of liver diseases and disorders [8].…”

“…The comparison of the means of groups 2-8 against the control was done using the Tukey Multiple Comparison Test. The malondialdehyde (MDA) levels showed significant increase (p<0.05) in groups 2, 3, 4, 5, 6, 7, & 8 when compared with the control group in the first week and the levels in the pretreated groups(3,4,5,6,7,8) were all reduced compared to the toxicity group (group 2) showing recovery of the system as a result of the antioxidant pretreatments.The comparison of MDA levels between groups 3 and 8, groups 4 and 7 was insignificantly different (p>0.05) in the 1 st week as reflected inTable 3.The means of superoxide dismutase (SOD) of all the groups in the 1 st week were compared together using ANOVA and found to be significantly different (p<0.05, F=2246).The comparison of the means of groups 2-8 against the control was done using the Tukey Multiple Comparison Test. The Superoxide Dismutase (SOD) levels in the 1 st week showed a significant decrease (p<0.05) in groups 2, 4, 5, & 6 and a significant increase (p<0.05) in group 3 & 8.…”

Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial

“…A recent systematic review found ‘limited evidence’ to support the use as a primary analgesic in ED setting when compared with opioid and other active comparators 13. In our study, we used oral paracetamol as the comparator, as we were assessing the efficacy of paracetamol in these two formulations as an adjunct to opioid analgesia regimes rather than a replacement.…”

Managing Pediatric Pain in the Emergency Department

“…A recent systematic review of RCTs that evaluated intravenous paracetamol for acute pain in the ED concluded that evidence to support its use in adults is limited [72], and none of the 14 included studies described how it performed in children. Two adult studies provided intriguing results: intravenous paracetamol was better than intravenous morphine to decrease pain at 15 and 30 min in patients with headache secondary to head trauma without anomalies in clinical examination and imaging studies and in patients with renal colic, respectively [73,74].…”