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Yet Again – Acetaminophen IV a Big Loser

August 31, 2018

Written by Clay Smith

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Patients over age 65 did not have superior pain control with hydromorphone 0.5mg IV + acetaminophen (APAP) 1000mg IV vs. hydromorphone + placebo.

Why does this matter?
Reducing medications that are sedating is important, especially in elderly patients.  Also, reducing the amount of opiates used may decrease the risk of downstream misuse.  Would addition of IV APAP help?

Not a good adjunct
This was a randomized double-blinded trial of 159 adults over age 65 in the ED who had acute severe pain (baseline for most was ≥8/10).  They received either hydromorphone 0.5mg IV + APAP 1000mg IV or hydromorphone 0.5mg IV + placebo.  Pain score (numerical rating scale 0 to 10) at 60 minutes was not different nor was the percentage who requested additional pain medication at 60 minutes, each about 29%.  They anticipated but did not find a 1.3 point greater drop in those who received APAP.  Rather the APAP group dropped by only 0.6, which was not statistically or clinically different.

Randomized Clinical Trial of IV Acetaminophen as an Analgesic Adjunct for Older Adults with Acute Severe Pain.  Acad Emerg Med. 2018 Aug 17. doi: 10.1111/acem.13556. [Epub ahead of print]
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Reviewed by Thomas Davis

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