A Randomised Control Trial Comparing the Efficacy of Tramadol and Paracetamol against Ketorolac and Paracetamol in the Management of Musculoskeletal Pain in the Emergency Department

Abstract

Background: This study aimed to compare the efficacy, acceptance and side effects of intramuscular tramadol and ketorolac in combination with oral paracetamol in the emergency setting. Materials and methods: This was a randomised, double blind controlled trial. Patients aged 18 years or above with moderate to severe musculoskeletal pain were recruited. Patients with known allergy, currently on psychiatric medication, with alcohol or opioid dependence, during pregnancy and with major systemic illness were excluded. Tramadol 100 mg or ketorolac 30 mg was given intramuscularly together with paracetamol 500 mg per oral. They were then bed rested in the observation ward for one hour. Visual analogue scale (VAS), satisfaction score, vital signs and side effects were recorded. Results: Altogether, 78 (M: 43, F: 35) subjects were recruited from June to September 2005, with equal number in each arm. The mean age was 39.9 for the tramadol group and 43.9 for the ketorolac group. Most of them suffered from back pain (66.7%). There was a significant difference in VAS improvement between the two groups (0.88; P=0.01). However, there were no significant differences in patients' satisfaction score and admission rate. The incidence of side effects was similar between the two groups (tramadol 19, ketorolac 17), mainly dry mouth, and none were major. The tramadol group had more nausea. Conclusion: The analgesic effect of the tramadol and paracetamol combination is as effective as the ketorolac and paracetamol combination. Tramadol is well tolerated and relatively safe. It is also cheaper than ketorolac. Hence, we recommend tramadol and paracetamol combination for acute moderate to severe musculoskeletal pain in the emergency setting.

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Similarly, in patients undergoing hip arthroplasty, preoperative administration of parecoxib offered no advantage compared with postoperative use; opioid-sparing was again seen in both groups compared with placebo (Martinez et al, 2007 Level II). Pain relief was also no better when parecoxib was given before incision compared with administration at the end of surgery in patients undergoing colorectal surgery (Lee et al, 2008 Level II).…”

“…For acute musculoskeletal pain, IM tramadol was similar to ketorolac in efficacy and side effects, when both were combined with oral paracetamol (Lee et al, 2008 Level II).…”

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

“…Seven of the 72 included studies [ 56 , 59 , 60 , 62 , 71 , 80 , 87 ] were scored at a high overall risk of bias (eTable 3); all investigated opioid-related adverse events. More than one-third of included studies (25 studies) [ 35 , 36 , 45 , 47 , 51 , 53 , 56 , 57 , 59 , 62 , 63 , 67 , 71 , 73 , 75 , 77 , 80 , 85 , 87 , 88 , 90 , 92 , 94 , 95 , 101 ] were considered as having high or unsure risk of attribution bias due to the lack of reporting of loss to follow-up in randomised controlled trials or data completion rate not reported in observational studies.…”

A Comparative Study of Tramadol and Ketorolac for Pain Management in Post-Operative Patients with Appendectomy

“…17 Lee H et al in his study concluded that tramadol with paracetamol combination is as effective as ketorolac with paracetamol combination. 18 Other studies that concluded ketorolac to be as effective as tramadol were regarding maxillofacial surgery, 19 abdominal surgery. 20 Although we observed both the drugs were having a similar duration of the pain-free interval which proves their effectiveness in pain management, our next concern was safety.…”