Written by Clay Smith
For adults with severe pain in the ED, IV hydromorphone provided significantly better pain control than IV acetaminophen (APAP) but resulted in more nausea and vomiting.
Why does this matter?
There is a move to use non-opiates for pain in the ED. But do they work? Prior studies have shown lackluster results. For example, IV APAP was no better than oral. A Cochrane review found it reduced post-op pain more than placebo, but few studies compared it with an opiate.
You'll never guess if hydromorphone or acetaminophen was better
This was a double-blinded RCT in 206 adults in the ED with severe pain who were randomized to receive either hydromorphone 1mg or APAP 1g IV. At 60 minutes, pain on a 0 to 10 scale dropped 5.3 points for hydromorphone and only 3.3 points for APAP. The downside is more patients had nausea/vomiting with hydromorphone. It is notable that IV APAP also reduced pain, although it's expensive and less effective. It has this going for it - at least patients won't feel nauseated.
See this WaPo take on The growing case against IV APAP.
Randomized Controlled Trial of Intravenous Acetaminophen Versus Intravenous Hydromorphone for the Treatment of Acute Pain in the Emergency Department. Ann Emerg Med. 2018 Aug 14. pii: S0196-0644(18)30550-X. doi: 10.1016/j.annemergmed.2018.06.019. [Epub ahead of print]
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Reviewed by Thomas Davis