PMID- 37173122
OWN - NLM
STAT- MEDLINE
DCOM- 20231219
LR  - 20231219
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Linking)
VI  - 40
IP  - 7
DP  - 2023 Jul
TI  - 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.
PG  - 499-508
LID - 10.1136/emermed-2022-212869 [doi]
AB  - OBJECTIVE: Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and 
      opiates/opioids, administered parenterally via intravenous or intramuscular 
      route, are widely used to provide analgesia for patients with moderate to severe 
      pain. This systematic review and meta-analysis evaluated the level of analgesia 
      provided by intravenous paracetamol (IVP) alone compared with NSAIDs (intravenous 
      or intramuscular), or opioids (intravenous) alone in adults attending the ED with 
      acute pain. METHODS: Two authors independently searched PubMed (MEDLINE), Web of 
      Science, Embase (OVID), Cochrane Library, SCOPUS and Google Scholar (3 March 
      2021-20 May 2022) for randomised trials without any language or date restriction. 
      Clinical trials were evaluated using the Risk of Bias V.2 tool. The primary 
      outcome was mean difference (MD) for pain reduction at 30 min (T30) post 
      analgesia delivery. The secondary outcomes were MD in pain reduction at 60, 90 
      and 120 min; the need for rescue analgesia; and the occurrence of adverse events 
      (AEs). RESULTS: Twenty-seven trials (5427 patients) were included in the 
      systematic review and 25 trials (5006 patients) in the meta-analysis. There was 
      no significant difference in pain reduction at T30 between the IVP group and 
      opioids (MD -0.13, 95% CI -1.49 to 1.22) or IVP and NSAIDs (MD -0.27, 95% CI -1.0 
      to 1.54. There was also no difference at 60 min, IVP group versus opioid group 
      (MD -0.09, 95% CI -2.69 to 2.52) or IVP versus NSAIDs (MD 0.51, 95% CI 0.11 to 
      0.91). The quality of the evidence using Grading of Recommendations, Assessments, 
      Development and Evaluations methodology was low for MD in pain scores.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), with no 
      difference found between the IVP group and the opioid group (RR: 1.07, 95% CI 
      0.67 to 1.70). AEs were 50% lower in the IVP group compared with the opioid group 
      (RR: 0.50, 95% CI 0.40 to 0.62), whereas no difference was observed in the IVP 
      group compared with the NSAID group (RR: 1.30, 95% CI 0.78 to 2.15). CONCLUSION: 
      In patients presenting to the ED with a diverse range of pain conditions, IVP 
      provides similar levels of pain relief compared with opiates/opioids or NSAIDs at 
      T30 post administration. 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. PROSPERO REGISTRATION NUMBER: 
      CRD42021240099.
CI  - (c) Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Qureshi, Isma
AU  - Qureshi I
AUID- ORCID: 0000-0003-0952-0208
AD  - Emergency Medicine, Hamad General Hospital, Doha, Qatar.
FAU - Abdulrashid, Khadiga
AU  - Abdulrashid K
AUID- ORCID: 0000-0003-1564-9307
AD  - Public Health, Qatar University College of Health Sciences, Doha, Qatar 
      ka1305102@qu.edu.qa.
AD  - Primary Health Care Corporation, Doha, Qatar.
FAU - Thomas, Stephen H
AU  - Thomas SH
AD  - Emergency Medicine, Hamad General Hospital, Doha, Qatar.
AD  - Queen Mary University of London Barts and The London School of Medicine and 
      Dentistry, London, UK.
FAU - Abdel-Rahman, Manar E
AU  - Abdel-Rahman ME
AUID- ORCID: 0000-0001-9968-9853
AD  - Public Health, Qatar University College of Health Sciences, Doha, Qatar.
FAU - Pathan, Sameer A
AU  - Pathan SA
AD  - Emergency Medicine, Hamad General Hospital, Doha, Qatar.
AD  - Queen Mary University of London Barts and The London School of Medicine and 
      Dentistry, London, UK.
AD  - School of Public health and Preventive medicine, Monash University, Melbourne, 
      Victoria, Australia.
FAU - Harris, Tim
AU  - Harris T
AD  - Emergency Medicine, Hamad General Hospital, Doha, Qatar.
AD  - Queen Mary University of London Barts and The London School of Medicine and 
      Dentistry, London, UK.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20230512
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
RN  - 362O9ITL9D (Acetaminophen)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Acetaminophen/administration & dosage/adverse effects
MH  - *Acute Pain/drug therapy
MH  - *Analgesics, Opioid/administration & dosage/adverse effects
MH  - *Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse effects
MH  - Administration, Intravenous
MH  - Injections, Intramuscular
MH  - Emergency Service, Hospital
MH  - Randomized Controlled Trials as Topic
MH  - Severity of Illness Index
MH  - Treatment Outcome
OTO - NOTNLM
OT  - analgesia
OT  - effectiveness
OT  - efficiency
OT  - emergency care systems
OT  - emergency department
COIS- Competing interests: None declared.
EDAT- 2023/05/13 15:12
MHDA- 2023/06/26 06:41
CRDT- 2023/05/12 21:23
PHST- 2022/09/28 00:00 [received]
PHST- 2023/04/17 00:00 [accepted]
PHST- 2023/06/26 06:41 [medline]
PHST- 2023/05/13 15:12 [pubmed]
PHST- 2023/05/12 21:23 [entrez]
AID - emermed-2022-212869 [pii]
AID - 10.1136/emermed-2022-212869 [doi]
PST - ppublish
SO  - Emerg Med J. 2023 Jul;40(7):499-508. doi: 10.1136/emermed-2022-212869. Epub 2023 
      May 12.