A randomised controlled trial of paracetamol and ibuprofen with or without codeine or oxycodone as initial analgesia for adults with moderate pain from limb injury

Research output: Contribution to journalArticleResearchpeer-review

13 Citations (Scopus)

Abstract

Objective: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Method: Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 × 500 mg paracetamol and 2 × 200 mg ibuprofen with 2 × 100 mg thiamine (non-opioid), 2 × 30 mg codeine (codeine) or 2 × 5 mg oxycodone tablets (oxycodone). Primary outcome: difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Results: Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95% CI) between groups at 30 min were as follows: non-opioid versus codeine −2.6 (−8.8 to 3.6); non-opioid versus oxycodone −2.7 (−9.3 to 3.9); codeine versus oxycodone 0.1 (−6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were −13.5, −16.1 and −16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6% (64.7–87.5), 81.0% (67.2–89.0) and 73.6% (59.7–84.7) and adverse events by 3.3% (0.4–11.3), 1.6% (0.4–8.7) and 16.9% (8.4–29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: −23.2 and −18.7 mm for non-opioid; −30.7 and −33.3 mm for codeine; and −26.1 and −31.7 mm for oxycodone. Conclusion: At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.

Original languageEnglish
Pages (from-to)666-672
Number of pages7
JournalEMA - Emergency Medicine Australasia
Volume28
Issue number6
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • analgesia
  • emergency department
  • ibuprofen
  • opioid
  • paracetamol
  • randomised controlled trial

Cite this

@article{f780aef54d2e49f3a2795478a37556fa,
title = "A randomised controlled trial of paracetamol and ibuprofen with or without codeine or oxycodone as initial analgesia for adults with moderate pain from limb injury",
abstract = "Objective: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Method: Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 × 500 mg paracetamol and 2 × 200 mg ibuprofen with 2 × 100 mg thiamine (non-opioid), 2 × 30 mg codeine (codeine) or 2 × 5 mg oxycodone tablets (oxycodone). Primary outcome: difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Results: Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95{\%} CI) between groups at 30 min were as follows: non-opioid versus codeine −2.6 (−8.8 to 3.6); non-opioid versus oxycodone −2.7 (−9.3 to 3.9); codeine versus oxycodone 0.1 (−6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were −13.5, −16.1 and −16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6{\%} (64.7–87.5), 81.0{\%} (67.2–89.0) and 73.6{\%} (59.7–84.7) and adverse events by 3.3{\%} (0.4–11.3), 1.6{\%} (0.4–8.7) and 16.9{\%} (8.4–29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: −23.2 and −18.7 mm for non-opioid; −30.7 and −33.3 mm for codeine; and −26.1 and −31.7 mm for oxycodone. Conclusion: At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.",
keywords = "analgesia, emergency department, ibuprofen, opioid, paracetamol, randomised controlled trial",
author = "Andis Graudins and Robert Meek and Jacqueline Parkinson and Diana Egerton-Warburton and Alastair Meyer",
year = "2016",
month = "12",
day = "1",
doi = "10.1111/1742-6723.12672",
language = "English",
volume = "28",
pages = "666--672",
journal = "EMA - Emergency Medicine Australasia",
issn = "1742-6731",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - A randomised controlled trial of paracetamol and ibuprofen with or without codeine or oxycodone as initial analgesia for adults with moderate pain from limb injury

AU - Graudins, Andis

AU - Meek, Robert

AU - Parkinson, Jacqueline

AU - Egerton-Warburton, Diana

AU - Meyer, Alastair

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objective: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Method: Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 × 500 mg paracetamol and 2 × 200 mg ibuprofen with 2 × 100 mg thiamine (non-opioid), 2 × 30 mg codeine (codeine) or 2 × 5 mg oxycodone tablets (oxycodone). Primary outcome: difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Results: Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95% CI) between groups at 30 min were as follows: non-opioid versus codeine −2.6 (−8.8 to 3.6); non-opioid versus oxycodone −2.7 (−9.3 to 3.9); codeine versus oxycodone 0.1 (−6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were −13.5, −16.1 and −16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6% (64.7–87.5), 81.0% (67.2–89.0) and 73.6% (59.7–84.7) and adverse events by 3.3% (0.4–11.3), 1.6% (0.4–8.7) and 16.9% (8.4–29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: −23.2 and −18.7 mm for non-opioid; −30.7 and −33.3 mm for codeine; and −26.1 and −31.7 mm for oxycodone. Conclusion: At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.

AB - Objective: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Method: Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 × 500 mg paracetamol and 2 × 200 mg ibuprofen with 2 × 100 mg thiamine (non-opioid), 2 × 30 mg codeine (codeine) or 2 × 5 mg oxycodone tablets (oxycodone). Primary outcome: difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Results: Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95% CI) between groups at 30 min were as follows: non-opioid versus codeine −2.6 (−8.8 to 3.6); non-opioid versus oxycodone −2.7 (−9.3 to 3.9); codeine versus oxycodone 0.1 (−6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were −13.5, −16.1 and −16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6% (64.7–87.5), 81.0% (67.2–89.0) and 73.6% (59.7–84.7) and adverse events by 3.3% (0.4–11.3), 1.6% (0.4–8.7) and 16.9% (8.4–29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: −23.2 and −18.7 mm for non-opioid; −30.7 and −33.3 mm for codeine; and −26.1 and −31.7 mm for oxycodone. Conclusion: At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.

KW - analgesia

KW - emergency department

KW - ibuprofen

KW - opioid

KW - paracetamol

KW - randomised controlled trial

UR - http://www.scopus.com/inward/record.url?scp=84992653723&partnerID=8YFLogxK

U2 - 10.1111/1742-6723.12672

DO - 10.1111/1742-6723.12672

M3 - Article

VL - 28

SP - 666

EP - 672

JO - EMA - Emergency Medicine Australasia

JF - EMA - Emergency Medicine Australasia

SN - 1742-6731

IS - 6

ER -