In older adults who present to the emergency department with severe pain, is a single dose of intravenous acetaminophen as effective as a single dose of hydromorphone to relieve pain?
For older adults who present to an emergency department with acute pain, both intravenous acetaminophen and intravenous hydromorphone produced similar pain reduction, on average. However, neither, on average, produced dramatic relief from pain, and 1 in 4 patients did not notice any pain relief 1 hour after treatment. Hydromorphone produced slightly lower average pain scores, but a substantial percentage of patients treated with either analgesic will need additional pain treatment.
Plan de l'etude:
Randomized controlled trial (double-blinded)
Self-funded or unfunded
These researchers enrolled 162 patients, 65 years and older, who presented to 1 of 2 emergency departments with acute pain (average score 9 out of 10 on a verbal pain scale) deemed to require intravenous opioid treatment. More than half the patients eligible for the study declined to participate. The patients, using concealed allocation, were randomized to receive intravenous acetaminophen 1000 mg over 10 minutes or hydromorphone (Dilaudid) 0.5 mg via slow intravenous push. Each treatment was paired with a placebo to mask treatment assignment. The main study outcome, pain scores at 1 hour, were decreased in both groups — an average decrease of 3.6 points with acetaminophen and 4.6 points with hydromorphone (difference 1.0; 95% CI 0.1 - 2.0). In other words, patients in both groups reported an average pain level between 4 and 6 after 1 hour. One-quarter of the participants did not experience clinically noticeable improvement in pain; that is, a decrease in pain of at least 1.3 points. The percentage of patients who received additional analgesic while in the emergency department was similar between the 2 groups: 46% and 38%)
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine