Paracetamol-codeine compared to ketorolac for pain control in the Emergency Department.
OBJECTIVE
Paracetamol /codeine has shown a strong analgesic activity in several studies conducted among different kind of subjects, including those with trauma. Nevertheless, its efficacy in patients accessing the Emergency Department (ED) for different kind of pain has never been tested.


METHODS
This is a cross-sectional, observational, prospective, cohort study. Inclusion criteria were patients > 18 year old presenting to the ED for localized traumatic or inflammatory pain involving only extremities. Numeric scale (NRS) was recorded thirty minutes and two hours after the administration of the analgesic therapy, consisting of 15 mg of ketorolac or 1000 mg/60 mg of paracetamol/ codeine, both orally.


RESULTS
Two-hundred patients were consecutively enrolled; 87 were treated with paracetamol/codeine and 113 with ketorolac. The combination paracetamol/codeine resulted to be not inferior to ketorolac in non-traumatic pain group and trauma group (p = 0.635 and p = 0.482, respectively). Compared to ketorolac, the combination paracetamol/codeine exerted a significantly higher analgesic activity in patients with fractures and muscular pain (p = 0.044) and was more effective in acute pain (p = 0.002), with a significant effect two hours after the administration (p = 0.029).


CONCLUSIONS
Paracetamol/codeine is equivalent to ketorolac in non-traumatic pain and post-traumatic pain, but is superior in acute pain and in patients with fractures and muscular pain. Those results play in favor of the use of the combination paracetamol/codeine in patients accessing the ED for non-traumatic or traumatic pain of the extremities.
Emergency Department, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. francesco.franceschi@rm.unicatt.it.
F
F
Buccelletti
D
D
Marsiliani
G
G
Zuccalà
P
P
Iacomini
L
L
Proietti
E
E
Pola
G
G
Zirio
M
M
Genitiempo
R
R
Marrocco
C
C
Conti
C
C
Brunetti
L
L
Rocchi
G
G
Merendi
G
G
D'Aurizio
E
E
Gilardi
F
F
Franceschi
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000082:Acetaminophen / Q000008:administration & dosage; D059787:Acute Pain / Q000175:diagnosis / Q000453:epidemiology; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003061:Codeine / Q000008:administration & dosage; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D020910:Ketorolac / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D011446:Prospective Studies
D000082:Acetaminophen; C526278:acetaminophen, codeine drug combination; D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003061:Codeine; D004338:Drug Combinations; D020910:Ketorolac