Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen400 mg compared with those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: A randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model

Litkowski, Leonard J.; Christensen, Steven; Adamson, Dennis N.; Dyke, Thomas E. Van; Han, Seung-Ho; Newman, Ken

doi:10.1016/j.clinthera.2005.04.010

Cited by 70 publications

(41 citation statements)

References 20 publications

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“…Similarly, a study of dental pain following extraction of impacted third molars that compared the oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (7.5 mg/500 mg) did not find sizeable or statistically significant differences in pain intensity or pain relief summed over a 6-hour period following a single dose of each combination analgesic. 6 In our study, nausea was significantly more common in patients treated with oxycodone/acetaminophen than those treated with hydrocodone/acetaminophen (17.1% vs. 7.1%, respectively; Table 3). The magnitude and direction of the findings are somewhat similar to those of the postoperative dental study (23% vs. 16%, respectively), although that difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 78%

“…7 In our study, dizziness was also significantly more frequent in patients who received oxycodone/acetaminophen (5 mg/325 mg) than in those who received hydrocodone/acetaminophen (5 mg/325 mg; 17.0% vs. 7.2%; Table 3). Litkowski et al 6 detected no difference in the incidences of dizziness between oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (5 mg/325 mg), which they found to be 5% versus 2%, respectively. The incidences of dizziness in two other studies were 10% for oxycodone/acetaminophen (5 mg/325 mg) 8 and 14% for hydrocodone/acetaminophen (5 mg/325 mg).…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] A second study of dental pain comparing oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (7.5 mg/500 mg) found the efficacy and side effect profile to be similar. 6 The outcomes for the above studies were at 1 and 6 hours, respectively.…”

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confidence: 99%

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Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short‐term Pain Management in Adults Following ED Discharge

Chang

Bijur

Holden

et al. 2015

Academic Emergency Medicine

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Objectives The objective was to test the hypothesis that oxycodone/acetaminophen provides superior analgesia to hydrocodone/acetaminophen for the treatment of acute extremity pain following emergency department (ED) discharge. Methods This was a prospective, randomized, double‐blind clinical trial of nonelderly adult ED patients with acute musculoskeletal extremity pain, randomly allocated at discharge to receive oxycodone/acetaminophen (5 mg/325 mg) or hydrocodone/acetaminophen (5 mg/325 mg). The primary outcome was the between‐group difference in improvement in numerical rating scale (NRS) pain scores over a 2‐hour period following the most recent ingestion of study drug, obtained during telephone contact 24 hours after ED discharge. Secondary outcomes included proportionate decrease in pain, comparative side‐effect profiles, and patient satisfaction. Results A total of 240 patients were enrolled. The final sample consisted of 220 patients, 107 randomly allocated to oxycodone/acetaminophen and 113 to hydrocodone/acetaminophen. At 24 hours after ED discharge, the mean NRS pain scores prior to the most recent dose of outpatient pain medication were 7.8 and 7.9 in the oxycodone/acetaminophen and hydrocodone/acetaminophen groups, respectively. The mean decreases in pain scores over 2 hours were 4.4 NRS units in the oxycodone/acetaminophen group versus 4.0 NRS units in the hydrocodone/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval = −0.2 to 1.1 NRS units). Satisfaction with the analgesics was similar. Conclusions This study design could not detect a clinically or statistically significant difference in analgesic efficacy between oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (5 mg/325 mg) for treatment of acute musculoskeletal extremity pain in adults following ED discharge. Both opioids reduced pain scores by approximately 50%.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short‐term Pain Management in Adults Following ED Discharge

Chang

Bijur

Holden

et al. 2015

Academic Emergency Medicine

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“…2 The popularity of hydrocodone/acetaminophen postdischarge is supported by two small clinical trials, 3,4 and several other studies that compare the efficacy of commonly prescribed oral opioids in different settings. [5][6][7][8][9] There has been increasing concern about the abuse of oral opioids in patients discharged from the ED. 10,11 The efficacy of hydrocodone versus codeine has not been adequately studied among discharged adult ED patients with acute pain.…”

mentioning

confidence: 99%

Randomized Clinical Trial of Hydrocodone/Acetaminophen Versus Codeine/Acetaminophen in the Treatment of Acute Extremity Pain After Emergency Department Discharge

Chang

Bijur

Munjal

et al. 2014

Academic Emergency Medicine

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ObjectivesThe objective was to test the hypothesis that hydrocodone/acetaminophen (Vicodin [5/500]) provides more efficacious analgesia than codeine/acetaminophen (Tylenol #3 [30/300]) in patients discharged from the emergency department (ED). Both are currently Drug Enforcement Administration (DEA) Schedule III narcotics.MethodsThis was a prospective, randomized, double‐blind, clinical trial of patients with acute extremity pain who were discharged home from the ED, comparing a 3‐day supply of oral hydrocodone/acetaminophen (5 mg/500 mg) to oral codeine/acetaminophen (30 mg/300 mg). Pain was measured on a valid and reproducible verbal numeric rating scale (NRS) ranging from 0 to 10, and patients were contacted by telephone approximately 24 hours after being discharged. The primary outcome was the between‐group difference in improvement in pain at 2 hours following the most recent ingestion of the study drug, relative to the time of phone contact after ED discharge. Secondary outcomes compared side‐effect profiles and patient satisfaction.ResultsThe median time from ED discharge to follow‐up was 26 hours (interquartile range [IQR] = 24 to 39 hours). The mean NRS pain score before the most recent dose of pain medication after ED discharge was 7.6 NRS units for both groups. The mean decrease in pain scores 2 hours after pain medications were taken were 3.9 NRS units in the hydrocodone/acetaminophen group versus 3.5 NRS units in the codeine/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval [CI] = –0.3 to 1.2 NRS units). No differences were found in side effects or patient satisfaction.ConclusionsBoth medications decreased NRS pain scores by approximately 50%. However, the oral hydrocodone/acetaminophen failed to provide clinically or statistically superior pain relief compared to oral codeine/acetaminophen when prescribed to patients discharged from the ED with acute extremity pain. Similarly, there were no clinically or statistically important differences in side‐effect profiles or patient satisfaction. If the DEA reclassifies hydrocodone as a Schedule II narcotic, as recently recommended by its advisory board, our data suggest that the codeine/acetaminophen may be a clinically reasonable Schedule III substitute for hydrocodone/acetaminophen at ED discharge. These findings should be regarded as tentative and require independent validation in similar and other acute pain models.

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“…Th e same reviewer assessed the full text articles and determined that 14 of the 26 off ered quantitative results that could be analyzed using the GRADE-pro software [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Th e remaining 12 articles were excluded because they did not compare both drugs assessed in a PICO question [42][43][44][45][46][47], compared analgesics not addressed in the seven P ICO qu estions (such as acetaminophen alone) [48,49], used unconventional medication dosing [50,51], used non-validated pain me asurement scales [52,53], and/or unusual study designs [50].…”

Section: Resultsmentioning

confidence: 99%

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1]. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20]. I n addi tion to a compromised patient experience, sub-optimal treatment of pain will result in decreased department fl ow, increased wait times, more return visits to the ED, and increased hospitalization rates.Very few evidence-based resources and guideli nes exis t to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand [21] was focused primarily on treating pain perioperatively and did not include stratifi ed or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specifi c guidance. Emergency physicia ns need an eff ective, evidenced-based approach to analyze and apply the options available for acute pain management.Th e objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED. Question formulationPrior to searching the literature we developed seven clinically-oriented questions based on a scoping of the literature and a review of locally utilized ED analgesic order sets. Th is initial surveying of medical literature and our local practice environment allowed us to identify the most commonly prescribed intravenous and oral analgesics used in adult EDs in our health care region.We then used the patient-intervention-comparisonoutcome (PICO) approach to develop our seven research questions (Table 1). Th is approach has been adopted by many authors of systematic reviews and guideline panels, including the Internati onal Liaison Committee on Resuscitation (ILCOR) and the American College of Chest Physicians (ACCP) [22][23][24]. It involves identifying a specifi c population or setting to which recommen dations may be applied. Subseq uently each question compares two specifi c management strategies (intervention and comparison). Fi nally, we defi ned important patient oriented outcomes (e. g., change in pain) as well as any adverse eff ects of the medication or other safety concerns.All seven draft questions were reviewed and revised through an iterative process involving all authors. Th ese seven cl...

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Cited by 70 publications

References 20 publications

Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short‐term Pain Management in Adults Following ED Discharge

Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short‐term Pain Management in Adults Following ED Discharge

Randomized Clinical Trial of Hydrocodone/Acetaminophen Versus Codeine/Acetaminophen in the Treatment of Acute Extremity Pain After Emergency Department Discharge

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

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