Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial

Pain is a common problem of patients in the emergency department (ED). An intravenous preparation of paracetamol has been available for 10–15 years, but comparisons with the oral form are limited. Therefore, Jeremy Furyk et al conducted this trial and showed no superiority of intravenous paracetamol compared with oral paracetamol as an adjunct to opioids in a heterogeneous group of adult patients with moderate to severe pain in the ED.  

The study aimed to discover if intravenous paracetamol was better than oral paracetamol as an adjunct to opioids in the treatment of mild to critical pain in the ED setting.

It was a randomised, prospective, double-blind, double-dummy, controlled trial in which patients received oral or intravenous paracetamol at a single academic tertiary care ED. The Visual Analogue Scale (VAS) pain reduction at 30 min was considered as a primary outcome. A clinically important change in pain was determined as 13 mm.

A total of 87 subjects with a mean age of 43.5 years were involved in the analysis. The 67.9 mm noticed as an overall mean baseline VAS pain score. Both formulations obtained a clinically notable mean pain score drop at 30 min, with no considerable difference amongst the groups with 14.6 mm in the oral group and 16.0 mm in the intravenous group (difference −1.4 mm). Both groups exhibited no variations among the secondary outcomes (patient satisfaction, postintervention intravenous opioid administration, length of stay, and side effects).  

A modest but clinically notable reduction in pain in each group was seen. No supremacy was expressed in this trial with intravenous paracetamol as compared to oral paracetamol regarding the effectiveness of analgesia and no variation was seen in the patient satisfaction, need for rescue analgesia or side effects or length of stay.