Randomized Clinical Trial of IV Acetaminophen as an Analgesic Adjunct for Older Adults with Acute Severe Pain.
Acad Emerg Med. 2018 Aug 17;:
Authors: Chang AK, Bijur PE, Ata A, Campbell C, Pearlman S, White D, Chertoff A, Restivo A, Gallagher EJ
OBJECTIVES: Older adults are at risk for undertreatment of pain. We examined IV acetaminophen as an analgesic adjunct to IV opioids in the care of older emergency department (ED) patients with acute severe pain.
METHODS: This was a randomized clinical trial conducted in two emergency departments in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 mg IV hydromorphone and 1 gram IV acetaminophen or 0.5 mg IV hydromorphone and 100 cc normal saline placebo. The primary outcome was the between group difference in improvement of NRS pain scores at 60 minutes. Secondary outcomes were the between group differences in the proportion of patients who chose to forgo additional pain medications at 60 minutes, the proportion who developed side effects, the proportion who required rescue analgesia, and between group differences in NRS pain scores at 5, 15, 30, and 45 minutes.
RESULTS: 81 patients were allocated to each arm. 80 patients in the IV acetaminophen arm and 79 patients in the placebo arm had sufficient data for analysis. At 60 minutes, patients in the hydromorphone + IV acetaminophen group improved by 5.7 NRS units while those in the hydromorphone + placebo group improved by 5.2 NRS units, for a difference of 0.6 NRS units (95% CI -0.4 to 1.5). 28.7% of patients in the hydromorphone + IV acetaminophen group wanted more analgesia at 60 minutes vs. 29.1% in the hydromorphone + placebo group, for a difference of -0.4% (-14.3 to 13.5%). These differences were neither clinically nor statistically significant. Safety profiles were similar in both groups.
CONCLUSION: In this randomized clinical trial, the addition of IV acetaminophen to IV hydromorphone as an adjunctive analgesic for acute, severe, pain in older adults provided neither clinically nor statistically superior pain relief when compared to hydromorphone alone within the first hour of treatment. This article is protected by copyright. All rights reserved.
PMID: 30118582 [PubMed - as supplied by publisher]