A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings

Aksel, Gökhan; Güler, Serdar; Doğan, Nurettın Özgür; Çorbacioğlu, Şk

doi:10.1177/0960327114551394

Cited by 21 publications

(33 citation statements)

References 14 publications

(28 reference statements)

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“…A total of eight randomized trials reported no detectable differences in the observed pain scores between IV APAP and comparator groups. Oguzturk et al., Azizkhani et al., and Aksel et al . reported of improved analgesia with morphine, tramadol, and topical lidocaine, respectively.…”

Section: Resultsmentioning

confidence: 98%

“…A detailed summary of rescue protocols described in the identified literature is presented in Table . The use of rescue analgesia was described in 10 randomized trials . In four trials, the number of patients who required rescue analgesia in the IV APAP group was fewer than those who received active comparators .…”

Section: Resultsmentioning

confidence: 99%

“…A detailed description of reported adverse events was not available . Data on the power and sample size to detect significant differences for the primary outcome were not presented in three trials . Protocols for the use of rescue analgesia were not mentioned in five trials .…”

Section: Resultsmentioning

confidence: 99%

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The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department

Sin

Wai

Tatunchak

et al. 2016

Academic Emergency Medicine

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Objectives: Acetaminophen (APAP) is a mainstay for pain management worldwide. The intravenous (IV) formulation has been widely used in Europe for more than 20 years in adults and children. In the United States, IV APAP obtained full approval from the Food and Drug Administration in 2010. There is emerging literature to suggest the use of IV APAP for pain reduction in the emergency department (ED). This evidence-based review examines the evidence pertaining to the use of IV APAP for acute pain control in the ED.Methods: The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of IV APAP for acute pain in the ED were included. Duplicate articles, unpublished reports, abstracts, review articles, and non-English literature were excluded. The primary outcome of interest in this review was the difference in pain score between IV APAP and active comparator or placebo from baseline to a cutoff time specified in the original trials. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant analgesics consumed by patients who received IV APAP. Methodologic quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria.Results: Fourteen RCTs with various methodologic flaws, which enrolled a total of 1,472 patients, met the inclusion criteria. The level of evidence for the individual trials ranged from very low to moderate. In three of the 14 trials, a significant reduction in pain scores was observed in patients who received IV APAP. The first trial found a significant reduction in mean pain scores when IV APAP was compared to IV morphine at 30 minutes after drug administration (4.7 AE 2.3 vs. 2.9 AE 2.2). In the second trial, patients who received IV APAP reported of lower pain scores (31.7 AE 18 mm, 95% confidence interval [CI] = 8.2 to 25.2 mm) compared to those who received IV morphine (48.3 AE 14.1 mm, 95% CI = 8.2 to 25.2 mm), 15 minutes after drug administration. A third trial found a significant reduction (p = 0.005) in the mean pain scores when IV APAP was compared to intramuscular piroxicam at 90 minutes after drug administration. In the remaining eight trials, pain scores were not statistically different when IV APAP was compared to other pain medications. The incidence of side effects associated with IV APAP was very low. Conclusions

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department

Sin

Wai

Tatunchak

et al. 2016

Academic Emergency Medicine

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“…A single randomized controlled clinical trial had been carried out in Turkey to evaluate this important aspect of scorpion sting management [10]. They evaluated three methods of pain relief: paracetamol (1 g intravenous single dose), topical 5% lidocaine and ice application over the sting site.…”

Section: Resultsmentioning

confidence: 99%

“…However, topical lidocaine had a significant and superior analgesic effect compared to other two modalities at 30 min post application/administration ( p < 0.001). There was no significant difference between the other two methods [10]. …”

Section: Resultsmentioning

confidence: 99%

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

Rodrigo

Gnanathasan

2017

Syst Rev

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BackgroundScorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting management.MethodsWe searched PubMed, EMBASE, Scopus, Web of Science and CINAHL and included controlled prospective clinical trials (randomized or non-randomized). The following interventions were assessed: adults and children with scorpion stings treated with (a) steroids vs. placebo, (b) different methods of pain relief, (c) antivenom vs. supportive treatment, (d) prazosin vs. supportive treatment, (e) antivenom vs. prazosin and (f) antivenom plus prazosin vs. prazosin alone. When trials had comparative outcomes, they were combined in a meta-analysis. Data was analysed with Review Manager 5. Dichotomous data were compared with relative risk (RR), and continuous data were compared with mean differences using a fixed effect model. There is no PROSPERO registration number for this study.ResultsAntivenom against Centruroides sp. are effective in reversing the clinical syndrome faster than no antivenom treatment in children (RR, 0.02; 95% CI, 0.01 to 0.06; 322 participants; three trials). Antivenom (against Mesobuthus tamulus) and prazosin combination is better than prazosin alone for faster resolution of symptoms (mean difference, −12.59 h; 95% CI, −14.01 to −11.17; 173 participants; three trials).ConclusionsThe polyvalent antivenom against Centruroides sp. in USA/Mexico and the monovalent antivenom against M. tamulus in India are effective for rapid resolution of symptoms. Prazosin is useful as an add-on therapy for M. tamulus stings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0469-8) contains supplementary material, which is available to authorized users.

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Toxinology: North American Scorpion Envenomations

Ruha¹

2017

Toxinology

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The Arizona bark scorpion, Centruroides sculpturatus, is the only scorpion endemic to the United States that produces a systemic envenomation in humans. Most stings do not result in serious symptoms however, and children are much more likely than adults to experience life-threatening effects. Serious envenomations are classified as Grade III and Grade IV. Findings include neuromuscular hyperactivity, with myoclonic muscle movements, fasciculations, thrashing and twisting of the torso, and restless agitation. Cranial nerve findings also occur and include opsoclonus, with dysconjugate and roving eye movements, as well as tongue fasciculations, hypersalivation, incoordination of pharyngeal muscles, and stridor. Local tissue findings at the sting site do not occur. Severe bark scorpion envenomation may be managed with supportive care and airway interventions as needed. Deaths occur from respiratory failure and hypoxia. An anti-Centruroides antivenom is available for treatment of serious bark scorpion stings. The antivenom reverses clinical toxicity within about an hour of administration. With or without antivenom treatment, most patients have full recovery from the envenomation in about 24 h.

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A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings

Cited by 21 publications

References 14 publications

The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department

The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

Toxinology: North American Scorpion Envenomations

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