title: Comparative Analgesic Efficacy of Oxycodone/Acetaminophen vs Codeine/Acetaminophen for Short-Term Pain Management Following ED Discharge.
abstract: OBJECTIVE
  To test the hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen following emergency department (ED) discharge.
  
  
  METHODS
  Prospective, randomized, double-blind, trial.
  
  
  METHODS
  Adult inner city ED.
  
  
  METHODS
  ED patients with acute extremity pain who were discharged home.
  
  
  METHODS
  Patients randomized to oxycodone/acetaminophen (5 mg/325 mg) or codeine/acetaminophen (30 mg/300 mg). The primary outcome, obtained via telephone one day after ED discharge, 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. Secondary outcomes included proportion of patients with >50% pain reduction, side-effect profile, and patient satisfaction.
  
  
  RESULTS
  Two hundred and forty patients were enrolled. Mean baseline NRS scores were 7.9 in both groups. Mean decrease over 2 hours was 4.5 NRS units in the oxycodone/acetaminophen group vs 4.2 NRS units in the codeine/acetaminophen group, for a clinically and statistically nonsignificant difference of 0.2 NRS units (95% CI -0.4-0.9 NRS units). Similarly, 66% vs 61% achieved >50% pain relief for a nonsignificant difference of 5% (95% CI -8% to 17%). Side-effect profile and patient satisfaction were similar.
  
  
  CONCLUSIONS
  Our hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen was rejected. Although pain within each group was reduced by more than half, the between-group difference was not significant. Pending independent validation, these unexpected findings suggest that codeine/acetaminophen, a Schedule III agent, may be a clinically reasonable outpatient opioid alternative to oxycodone/acetaminophen, a more tightly restricted Schedule II agent thought to be more prone to misuse.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Polly E
authors.initials: PE
authors.lastname: Bijur
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Lupow
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: E John
authors.initials: EJ
authors.lastname: Gallagher
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003061:Codeine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010098:Oxycodone / Q000008:administration & dosage*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000187:drug effects / Q000706:statistics & numerical data; D010351:Patient Discharge; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D010098:Oxycodone; D003061:Codeine
keywords: Codeine/Acetaminophen; Emergency Department; Oxycodone/Acetaminophen; Pain