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Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain.
Pain Pract. 2019 03; 19(3):275-282.PP

Abstract

OBJECTIVES

To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain.

METHODS

This is a single-blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30.

RESULTS

We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04).

CONCLUSION

Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.

Authors+Show Affiliations

Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.Emergency Department, Sahloul University Hospital, Sousse, Tunisia.Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia.Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia. Emergency Department, Sahloul University Hospital, Sousse, Tunisia.Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

30303612

Citation

Bouida, Wahid, et al. "Effect On Morphine Requirement of Early Administration of Oral Acetaminophen Vs. Acetaminophen/Tramadol Combination in Acute Pain." Pain Practice : the Official Journal of World Institute of Pain, vol. 19, no. 3, 2019, pp. 275-282.
Bouida W, Beltaief K, Msolli MA, et al. Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Pract. 2019;19(3):275-282.
Bouida, W., Beltaief, K., Msolli, M. A., Ben Marzouk, M., Boubaker, H., Grissa, M. H., Zorgati, A., Methamem, M., Boukef, R., Belguith, A., & Nouira, S. (2019). Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Practice : the Official Journal of World Institute of Pain, 19(3), 275-282. https://doi.org/10.1111/papr.12736
Bouida W, et al. Effect On Morphine Requirement of Early Administration of Oral Acetaminophen Vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Pract. 2019;19(3):275-282. PubMed PMID: 30303612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. AU - Bouida,Wahid, AU - Beltaief,Kaouthar, AU - Msolli,Mohamed Amine, AU - Ben Marzouk,Maryem, AU - Boubaker,Hamdi, AU - Grissa,Mohamed Habib, AU - Zorgati,Asma, AU - Methamem,Mehdi, AU - Boukef,Riadh, AU - Belguith,Asma, AU - Nouira,Semir, Y1 - 2019/02/04/ PY - 2018/03/04/received PY - 2018/08/29/revised PY - 2018/09/18/accepted PY - 2018/10/12/pubmed PY - 2019/6/18/medline PY - 2018/10/11/entrez KW - acute pain KW - analgesics KW - opioid KW - triage KW - visual analog pain scale SP - 275 EP - 282 JF - Pain practice : the official journal of World Institute of Pain JO - Pain Pract VL - 19 IS - 3 N2 - OBJECTIVES: To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain. METHODS: This is a single-blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30. RESULTS: We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04). CONCLUSION: Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits. SN - 1533-2500 UR - https://www.unboundmedicine.com/medline/citation/30303612/Effect_on_Morphine_Requirement_of_Early_Administration_of_Oral_Acetaminophen_vs__Acetaminophen/Tramadol_Combination_in_Acute_Pain_ L2 - https://doi.org/10.1111/papr.12736 DB - PRIME DP - Unbound Medicine ER -