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

Abstract

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%.

Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial

“…Regional anesthesia and Traditional Chinese Medicine may be challenging for ED physicians to master due to their specialized application. In order to maximize the analgesic effect and minimize adverse events, the combination of different analgesics applied at the right moment is of advantage, with oral hydrocodone/acetaminophen being the most frequently prescribed (18). Similar to the results of the present study, the majority of previous studies demonstrated that the onset time was 1-2 h, which hardly satisfied the time effectiveness required at the ED (8,18).…”

“…Achieving rapid pain relief is among the most desired factors in patients with displaced fractures presenting at the ED (19). Delay in pain relief by even one minute worsens the medical experience, while it is also associated with potential complications such as increased risk of cardiovascular events (18). American guidelines for pain management in the ED recommend the prioritization of pain relief, with administration of analgesics performed even prior to the establishment of an etiology (20).…”

“…In order to maximize the analgesic effect and minimize adverse events, the combination of different analgesics applied at the right moment is of advantage, with oral hydrocodone/acetaminophen being the most frequently prescribed (18). Similar to the results of the present study, the majority of previous studies demonstrated that the onset time was 1-2 h, which hardly satisfied the time effectiveness required at the ED (8,18). As a commonly used analgesic at the ED, intravenous morphine was reported to have a shorter analgesic onset time than other methods (28).…”

“…After providing consent, the participants eligible for the study were randomly assigned to treatment with oral hydrocodone/acetaminophen or intravenous morphine titration. In the oral hydrocodone/acetaminophen group, the dose of the tablet was 5 mg/500 mg (18), and only one dose was given. The method of intravenous administration was reported in a previous study (17).…”

Quantitative sensory testing measures individual pain responses in emergency department patients

“…Verbal numerical scales will be more practical for telephone or remote monitoring of pain after emergency care 34–36. Prior research indicates that a change of 1.3–1.6 cm in VAS is clinically important to ED patient experience 17–19.…”