A randomized controlled trial of oxycodone/acetaminophen versus acetaminophen alone for emergency department patients with musculoskeletal pain refractory to ibuprofen.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(18):7 Acad Emerg Med. 2021;28: 859–865.What this means for my practice?
The results of this study suggest that the addition of oxycodone to acetaminophen significantly improves pain relief 2 hours post-treatment compared to acetaminophen alone in acute musculoskeletal pain patients unresponsive to ibuprofen. However, there appears to be a greater risk of adverse events with oxycodone use. This study was limited by the site setting (urban emergency departments in socioeconomically depressed counties) which may not be generalizable, the use of a high ibuprofen dose which may not have been necessary, and lack of weight-adjusted dosing. Future studies are required.
Study Summary
Of the 393 acute musculoskeletal pain patients who received 600mg ibuprofen, 154 were unresponsive and were subsequently randomized to receive oral oxycodone/acetaminophen (n=77) or acetaminophen alone (n=77) for pain relief. The primary outcome of interest was the improvement in pain scores on a 0-10 point scale 2 hours post-treatment. Secondary outcomes included adequacy of analgesia, satisfaction with medication, and medication-induced adverse events. Results revealed significantly greater improvement in pain scores with oxycodone/acetaminophen vs. acetaminophen alone. No significant differences in satisfaction were observed. The rate of medication related adverse events was higher in the oxycodone/acetaminophen group vs. acetaminophen alone group (34% vs. 9%).
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