Acetaminophen, Nonsteroidal Anti‐inflammatory Drugs, or Combination of Both Analgesics in Acute Posttrauma Pain: A Randomized Controlled Trial

Abstract

Objectives Nonsteroidal anti‐inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve posttrauma pain in the emergency department (ED). However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining an NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of posttraumatic pain of the extremity after discharge from the ED. Methods This is a prospective, randomized controlled trial, carried out in a single ED from March 2017 to November 2018. The included patients were randomly assigned to receive paracetamol alone, high‐dose NSAID (piroxicam) alone, or a combination of paracetamol and high‐dose NSAID for 7 days after ED discharge. The primary outcome was need for additional oral analgesics. Secondary outcomes included the change of the visual numeric scale (VNS) between ED discharge (VNS D0) and 7 days later (VNS D7), ED revisits for residual pain, side effects, and patient satisfaction as assessed by a Likert satisfaction scale. Results The need for additional oral analgesics was comparable between the paracetamol–NSAID combination group (9.8%) and the paracetamol group (11.4%; p = 0.43). ED readmission rate was also comparable between the two groups at 5.6 and 5.8%, respectively (p = 0.86). In contrast, need for new analgesics and ED revisit rates were both more frequent in the high‐dose NSAID group. Mean VNS decreases on day 7 compared to day 0 were 66, 63, and 67%, respectively, in the paracetamol, NSAID, and paracetamol–NSAID combination groups (p = 0.32). Frequency of dissatisfaction was higher in the NSAID group. Side effects were more frequent in the NSAID and paracetamol–NSAID combination groups. Conclusion This study found that the combination of a high‐dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high‐dose NSAID alone for posttraumatic extremity pain.

Transcriptome Profiling of the Hippocampal Seizure Network Implicates a Role for Wnt Signaling during Epileptogenesis in a Mouse Model of Temporal Lobe Epilepsy

“…Mice received food saturated with pediatric Tylenol (3.2 mg/mL) for 24 h after surgery for analgesia, as required by local IACUC guidelines, and soft food daily until tissue extraction. Tylenol is not an anti-inflammatory drug [ 97 , 98 ], and non-steroidal anti-inflammatory drugs (NSAIDs) were not administered.…”

Parenteral Ready-to-Use Fixed-Dose Combinations Including NSAIDs with Paracetamol or Metamizole for Multimodal Analgesia—Approved Products and Challenges

“…There, according to the authors, the patients were randomized in blocks of four in a complete crossover manner according to a balanced, reduced Latin square design. Recently, Msolli et al [ 124 ] opted to explore the possible benefits of combining piroxicam with paracetamol in a single-blind study instead of using the typical double-blind approach. In this case, the randomization was performed by a blinded study investigator.…”

“…Concerning the clinical trial performed by Iorno et al [ 147 ], ketorolac was applied orally and intravenously based on an o.d. regimen and paracetamol every 8 h. Very recently, in the RCT published by Msolli et al [ 124 ], the authors conducted a trial combining piroxicam b.i.d. and paracetamol every 8 h [ 124 ].…”

“…regimen and paracetamol every 8 h. Very recently, in the RCT published by Msolli et al [ 124 ], the authors conducted a trial combining piroxicam b.i.d. and paracetamol every 8 h [ 124 ].…”

Development of novel paracetamol/naproxen co-crystals with an improvement in naproxen solubility.

“…Paracetamol combination therapy with an NSAID as a single tablet had exhibited a superior pharmacological activity than NSAIDs alone (10) . For instance, the formulation of low-doses of naproxen with paracetamol as a combination therapy to relief arthrosis pain demonstrated a better analgesic effect with a decrease in the incidence of toxicity and side effects which are accompanied with the treatment by high-doses of naproxen alone (11) .…”