November 2022

Authors

– Andy neill
– Dave Mccreary

Clinical Question

– Does IV paracetamol actually do much?

Paper title

– Intravenous acetaminophen does not reduce morphine use for pain relief in emergency department patients: A multicenter, randomized, double‐blind, placebo‐controlled trial

Author

– Minotti et al AEM 2022

Background

– IV paracetamol has become fairly ubiquitous in the UK and Ireland I think. It’s never been the most evidence based intervention and I think we often use it to justify our existence, ie we give a drip of something just so that the patient gets something they could otherwise buy in tesco. There is a bunch of RCT data out there but this trial in particular looked to see if it reduced morphine requirements and by extrapolation was it having a signficant analgesic effect

Methods

– multicentre placebo trial in 2 EDs switzerland. Lots of good EBM points in this trial
– day time hours recruitment which makes it more of a convenience sample but is pain really that different after midnight.
– pain 4 or more (which is quite a lot bar)
– excluded if pain relief in the preceding 6 hrs
– got morphine 0.1mg/kg (very standard) plus 1g paracetamol IV or a placebo IV
– pain measured every 15 mins following this, got additional morphine if pain still >4 every 15 mins
– primary outcome of morphine used

Results

– 200 patients, mostly tummy and flank pain with some extremity pain too.
– ~12mg morphine in each group to achieve pain relief

‌Thoughts

– well done study
– hard to argue for any great benfit for paracetamol here when you’re already getting moprhine.
– in reality we often use it to avoid giving an opiate (often for logistics like doctor administration or needing a trolley)
– for those who don’t need an opiate then it may well still have a role but if the gut is working then maybe just give PO?

•  Trans101: Avoiding a Trans Emergency – Ethan Wilson
• Notifiable Diseases – Ines Corcuera Hotz and Grace George
• Local Anaesthetics – Graham Gardner