Intravenous Acetaminophen vs. Ketorolac in Terms of Pain Management in Prehospital Emergency Services: A Randomized Clinical Trial

Abstract

Introduction: Although pain management in EDs has been fully addressed in clinical trials, prehospital settings have rarely been investigated. Objective: The present study was conducted to compare the effectiveness of intravenous acetaminophen with that of ketorolac in pre-hospital pain control. Method: This randomized clinical trial (RCT) was performed at a prehospital setting during EMS missions in Tehran, Iran. The eligible candidates comprised all patients over the age of 7 years with a complaint of moderate to severe pain. The patients were randomly assigned to two groups, one receiving 30 mg of intravenous (IV) ketorolac and the other 1 g of IV acetaminophen. The pain intensity was measured using a visual analog scale (VAS) before administering the analgesic and upon admission to the ED. Results: The present study was conducted on 150 patients aged 8-81 years with a mean age of 40.4 ± 17.7, including 84 (56%) males. The mean reduction in the pain score was 14.9±8.6 in the acetaminophen group and 16.0±8.8 in the ketorolac group. Univariate analyses suggested no statistically significant differences between the two groups in terms of delta pain score (pain reduction) (P=0.429). Conclusion: Based on the obtained findings, both ketorolac and acetaminophen could be administered for pain management in prehospital settings in both traumatic and non-traumatic patients in case their contraindications are considered.

1. Galinski M, Ruscev M, Gonzalez G, Kavas J, Ameur L, Biens D, et al. Prevalence and management of acute pain in prehospital emergency medicine. Prehosp Emerg Care. 2010;14(3):334-9.
2. Hennes H, Kim MK, Pirrallo RG. Prehospital pain management: a comparison of providers' perceptions and practices. Prehosp Emerg Care. 2005;9(1):32-9.
3. Hassankhani H, Soheili A, Vahdati SS. Pain Management in Prehospital Emergency Service: A Neglected Necessity in Iranian Healthcare System. Iranian J Emerg Med. 2018;5:16.
4. Farahmand S, Shafazand S, Alinia E, Bagheri-Hariri S, Baratloo A. Pain Management Using Acupuncture Method in Migraine Headache Patients; A Single Blinded Randomized Clinical Trial. Anesth Pain Med. 2018;8(6):e81688.
5. Dijkstra BM, Berben SA, van Dongen RT, Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain. 2014;18(1):3-19.
6. Hoogewijs J, Diltoer MW, Hubloue I, Spapen HD, Camu F, Corne L, et al. A prospective, open, single blind, randomized study comparing four analgesics in the treatment of peripheral injury in the emergency department. Eur J Emerg Med. 2000;7(2):119-23.
7. Woo WW, Man SY, Lam PK, Rainer TH. Randomized double-blind trial comparing oral paracetamol and oral nonsteroidal antiinflammatory drugs for treating pain after musculoskeletal injury. Ann Emerg Med. 2005;46(4):352-61.
8. Viallon A, Marjollet O, Guyomarch P, Robert F, Berger C, Guyomarch S, et al. Analgesic efficacy of orodispersible paracetamol in patients admitted to the emergency department with an osteoarticular injury. Eur J Emerg Med. 2007;14(6):337-42.
9. Craig M, Jeavons R, Probert J, Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emerg Med J. 2012;29(1):37-9.
10. Shear ML, Adler JN, Shewakramani S, Ilgen J, Soremekun OA, Nelson S, et al. Transbuccal fentanyl for rapid relief of orthopedic pain in the ED. Am J Emerg Med. 2010;28(8):847-52.
11. Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM. Acute pain management: scientific evidence: Australian and New Zealand College of Anaesthetists Melbourne; 2010.
12. Whitefield M, O'Kane CJ, Anderson S. Comparative efficacy of a proprietary topical ibuprofen gel and oral ibuprofen in acute soft tissue injuries: a randomized, double-blind study. J Clin Pharm Ther. 2002;27(6):409-17.
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IssueVol 3 No 4 (2019): Autumn (October) QRcode
SectionOriginal article
PMCIDPMC6789076
PMID31633092
Keywords
Acetaminophen Emergency Medical Services Ketorolac Pain Management
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mahshidfar B, Rezai M, Abbasi S, Farsi D, Hafezimoghadam P, Mofidi M, Almasi R, Khosravi S. Intravenous Acetaminophen vs. Ketorolac in Terms of Pain Management in Prehospital Emergency Services: A Randomized Clinical Trial. Front Emerg Med. 2019;3(4):e37.

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