title: Intravenous Acetaminophen for Renal Colic in the Emergency Department: Where Do We Stand?
abstract: BACKGROUND
  The efficacy, safety, opioid-sparing effects, and cost-benefit analyses of intravenous (IV) acetaminophen (APAP) in treating renal colic remain controversial.
  
  
  OBJECTIVE
  To evaluate the safety, efficacy, opioid-sparing effects, and cost-benefits of IV APAP in patients who present with renal colic in the emergency department (ED).
  
  
  METHODS
  We systematically searched PubMed (January 1970 to April 2016).
  
  
  METHODS
  Randomized controlled trials which evaluated IV APAP for renal colic in the ED were eligible. The clinical outcomes measured were change in pain scores from baseline, incidence of adverse events, use of rescue analgesia, and cost-benefits. Forest plots were constructed using the Mantel-Haenszel method in a random effect model to changes in pain scores from the baseline to designated intervals.
  
  
  RESULTS
  The analysis suggested a difference in pain reduction favoring IV APAP over morphine. IV APAP had a significant effect in pain reduction than IV morphine (difference in mean pain score reduction = 7.5 in a 100-point visual analog scale (VAS); 95% confidence interval [CI], 1.99-13.00; P = 0.008). There was mild-to-moderate study heterogeneity (I = 42%). No difference was observed when IV APAP was compared with intramuscular piroxicam for pain reduction (difference in mean pain score reduction = 0.17 in a VAS reduction ≥50% VAS; 95% CI, -0.22 to 0.57) and to intramuscular diclofenac (difference in mean pain score reduction = 0.00 in a numeric rating scale reduction ≥50%; 95% CI, -0.12 to 0.12). The analysis for nonsteroidal anti-inflammatory drugs versus IV APAP revealed no difference (difference in mean pain score reduction = 0.01 in a 100-point VAS; 95% CI, -0.10 to 0.13; P = 0.80).
  
  
  CONCLUSIONS
  In this meta-analysis, we found that data on the efficacy, safety, opioid-sparing effects, and cost-benefit analyses of IV APAP for renal colic were weak. Based on the available data, IV APAP should not be considered as an alternative to opioids or nonsteroidal anti-inflammatory drugs for the primary management of renal colic in the ED.
authors: 1Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; 2Department of Pharmacy, Division of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, NY; 3Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; 4Drug Regulatory Affairs M.S. Program, Arnold and Marie Schwartz College of Pharmacy, LIU Pharmacy, Brooklyn, NY; and 5Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY.
authors: Billy
authors: B
authors: Sin
authors: Kimberly
authors: K
authors: Koop
authors: Michelle
authors: M
authors: Liu
authors: Jun-Yen
authors: JY
authors: Yeh
authors: Pardeep
authors: P
authors: Thandi
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000627:therapeutic use; D061605:Administration, Intravenous; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D006801:Humans; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D056844:Renal Colic / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen