PMID- 35491963
OWN - NLM
STAT- MEDLINE
DCOM- 20220812
LR  - 20221015
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 29
IP  - 8
DP  - 2022 Aug
TI  - Intravenous acetaminophen does not reduce morphine use for pain relief in 
      emergency department patients: A multicenter, randomized, double-blind, 
      placebo-controlled trial.
PG  - 954-962
LID - 10.1111/acem.14517 [doi]
AB  - BACKGROUND: Pain is one of the main reasons to present to emergency departments 
      (EDs). Opioids are indispensable for acute pain management but are associated 
      with side effects, misuse, and dependence. The aim of this study was to test 
      whether a single dose of intravenous (IV) acetaminophen (paracetamol) can reduce 
      the use of morphine for pain relief and/or morphine-related adverse events (AEs). 
      METHODS: ED patients >18 years with acute pain (i.e., Numeric Rating Scale 
      [NRS] > 4) were screened for eligibility. Patients with analgesia in the past 
      6 h, chronic pain, or clinical instability were excluded. Patients were 
      randomized in a 1:1 ratio to receive either morphine 0.1 mg/kg and 1 g 
      acetaminophen IV or morphine 0.1 mg/kg and placebo IV. The intervention was 
      double-blinded. Additional morphine 0.05 mg/kg IV was administered every 
      15 minutes until pain relief (defined as NRS < 4) and whether the pain recurred. 
      The primary outcome was the mean morphine dose for pain relief. Secondary 
      outcomes were the total amount of morphine given, time to achieve pain relief, 
      and AEs. RESULTS: A total of 220 patients were randomized and 202 evaluated for 
      the primary outcome. The mean morphine dose for pain relief was similar in both 
      groups (acetaminophen 0.15 mg +/- 0.07 mg/kg, placebo 0.16 +/- 0.07 mg/kg). There 
      were no differences in the total amount of morphine given (acetaminophen 
      0.19 +/- 0.09 mg/kg, placebo 0.19 +/- 0.1 mg/kg), the time to achieve pain relief 
      (acetaminophen 30 min [95% CI 17-31 min], placebo 30 min [95% CI 30-35 min]), and 
      the frequency of AEs (overall 27.4%). Time to pain recurrence did not differ 
      significantly between the groups (hazard ratio 1.23 [0.76-1.98], p = 0.40). 
      CONCLUSIONS: In ED patients, acetaminophen had no additional effect on pain 
      control or morphine-sparing effect at the time of first morphine administration. 
      Titrated morphine with the algorithm used was highly effective, with 80% of all 
      patients reporting pain relief within 60 min of starting therapy.
CI  - (c) 2022 The Authors. Academic Emergency Medicine published by Wiley Periodicals 
      LLC on behalf of Society for Academic Emergency Medicine.
FAU - Minotti, Bruno
AU  - Minotti B
AUID- ORCID: 0000-0002-4820-9968
AD  - Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
FAU - Mansella, Gregory
AU  - Mansella G
AD  - Emergency Department, University Hospital Basel, University of Basel, Basel, 
      Switzerland.
FAU - Sieber, Robert
AU  - Sieber R
AD  - Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
FAU - Ott, Alexander
AU  - Ott A
AD  - Interdisciplinary Pain Center, Cantonal Hospital of St. Gallen, St. Gallen, 
      Switzerland.
FAU - Nickel, Christian H
AU  - Nickel CH
AD  - Emergency Department, University Hospital Basel, University of Basel, Basel, 
      Switzerland.
FAU - Bingisser, Roland
AU  - Bingisser R
AD  - Emergency Department, University Hospital Basel, University of Basel, Basel, 
      Switzerland.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20220522
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Analgesics, Non-Narcotic)
RN  - 0 (Analgesics, Opioid)
RN  - 362O9ITL9D (Acetaminophen)
RN  - 76I7G6D29C (Morphine)
SB  - IM
MH  - Acetaminophen/therapeutic use
MH  - *Acute Pain/diagnosis/drug therapy
MH  - *Analgesics, Non-Narcotic
MH  - Analgesics, Opioid/therapeutic use
MH  - Double-Blind Method
MH  - Emergency Service, Hospital
MH  - Humans
MH  - Morphine
MH  - Pain Management
MH  - Pain Measurement
MH  - Treatment Outcome
PMC - PMC9544852
COIS- All authors declare no conflict of interest.
EDAT- 2022/05/03 06:00
MHDA- 2022/08/13 06:00
PMCR- 2022/10/07
CRDT- 2022/05/02 05:44
PHST- 2022/04/22 00:00 [revised]
PHST- 2022/02/14 00:00 [received]
PHST- 2022/04/28 00:00 [accepted]
PHST- 2022/05/03 06:00 [pubmed]
PHST- 2022/08/13 06:00 [medline]
PHST- 2022/05/02 05:44 [entrez]
PHST- 2022/10/07 00:00 [pmc-release]
AID - ACEM14517 [pii]
AID - 10.1111/acem.14517 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2022 Aug;29(8):954-962. doi: 10.1111/acem.14517. Epub 2022 May 
      22.