BACKGROUND AND PURPOSE:

• Qureshi et al. (BMJ Emergency Medicine Journal, 2023) used meta-analysis to evaluate the level of analgesia provided by paracetamol (IVP) alone compared with NSAIDs (intravenous or intramuscular), or opioids (intravenous) alone in adults with acute pain in the emergency department setting

METHODS:

• Systematic review and meta-analysis
• Study inclusion criteria
  • Randomize trials
  • Studies that assessed adults in the ED with moderate to severe pain managed with paracetamol, NSAIDs, or opioids
  • Studies in which orally administered medications were excluded
• Primary outcome
  • Pain reduction at 30 min (T30) post analgesia delivery
• Secondary outcomes
  • Pain reduction at T60, T90 and T120
  • The need for rescue analgesia
  • Adverse events

RESULTS:

• 27 trials | 5427 patients (25 trials | 5006 patients in the meta-analysis)

Pain Reduction

• There was no significant difference in pain reduction at T30 between
  • IVP vs opioids: mean difference (MD) −0.13 (95% CI, −1.49 to 1.22)
  • IVP vs NSAIDs: MD −0.27 (95% CI, −1.0 to 1.54)
• There was no significant difference in pain reduction at T60
  • IVP vs opioids: MD −0.09 (95% CI, −2.69 to 2.52)
  • IVP vs NSAIDs: MD 0.51 (95% CI, 0.11 to 0.91)

Rescue Analgesia

• The need for rescue analgesia at T30 was significantly higher in the IVP group compared with the NSAID group
  • Risk ratio (RR) 1.50 (95% CI, 1.23 to 1.83)
• There was no difference in need for rescue analgesia at T30 for the IVP group vs the opioid group
  • RR 1.07 (95% CI, 0.67 to 1.70)

Adverse Events

• Adverse events were fewer in the IVP group compared to opioids
  • RR 0.50 (95% CI, 0.40 to 0.62)
• There was no difference for the IVP group compared to the NSAID group
  • RR 1.30 (95% CI, 0.78 to 2.15)

CONCLUSION:

• After 30 minutes, intravenous paracetamol provides the same amount of pain relief as opioids or NSAIDs for patient with moderate to severe pain in the ED
• The authors state

Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative

Learn More – Primary Sources:

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis