Comparison of Intravenous Ibuprofen and Intravenous Paracetamol Efficacy in the Management of Pain Associated with Soft Tissue Trauma in the Emergency Department: A Randomized, Double-Blind Study
Project no. 78 · Status: Kapanmış · 2016
Summary
Background:Soft tissue injury related pain is a clinical condition that requires treatment in the emergency medicine. Treatment given to patients should be effective, fast and reliable. Although there are studies on opioid, paracetamol and nonsteroidal anti-inflammatory drugs in pain efficacy in patients with soft tissue injury in the current literature, there are no randomized controlled studies regarding intravenous use of ibuprofen and compared with intravenous paracetamol. Methods:The study was designed as a prospective, randomized, double-blind study. The study was carried out in the Emergency Department of Ege University Medical Faculty Hospital which an educational and research hospital that provides emergency care as tertiary stage. Patients between 18-64 years of age who needed analgesic therapy due to soft tissue injury within 24 hours were included in the study. Patients who has chronic kidney failure, congestive heart failure, liver failure, gastrointestinal bleeding history, malignancy, asthma, chronic obstructive pulmonary disease, coronary artery disease, uncontrolled hypertension, presence of bleeding diathesis, pregnancy, lactation, ibuprofen or paracetamol allergy history, pain medication before admission, bone fracture or joint dislocation, presence of solid organ injury, could not give consent and could not be contacted (language problem) were excluded from the study. Intravenous (iv) ibuprofen (400 mg) and iv paracetamol (1000 mg) were given in a randomized double-blinded manner to patients who met the inclusion criteria and obtained consent. Pain scores were recorded according to the numerical rating scale (NRS) at rest and in activity at 0-15-30-45-60 minutes. The primary aim was to determine whether there was a difference in pain levels at 15-30-45-60 minutes for both drugs. The secondary purpose was planned to investigate whether there is a difference in need for additional analgesic treatment in patients and to provide major pain relief efficacy among drug groups according to NRS. Results:One hundred seventy two patients were analyzed for the study. Patients were divided into ibuprofen (n:86) and paracetamol (n:86) groups. Rest pain scores decreased after 60 minutes in both groups. However, the decrease in pain was found to be higher in patients given Intrafen (p = 0.005). When the decrease in both drug groups was examined separately, it was found statistically significant (p <0.001 for both). The significant difference between drug groups for the resting pain score was detected after 30th minutes. Activity pain scores were determined to decrease similarly from the beginning in both drug groups (p = 0.313) and this decrease was found significant for both drug groups (p <0.001). However, there was no statistically significant difference between the groups at all time points (p = 0.088). It was determined that the need for rescue medicine of patients was lower in the Intrafen group (p = 0.030). Conclusion:Intravenous ibuprofen and paracetamol provide effective pain control in emergency departmentpatients with soft tissue injury related pain. Intravenous ibuprofen provides statistically significant pain control compared to iv paracetamol from the 30th minute at rest. Pain control rates are higher in patients taking iv ibuprofen than paracetamol and there is less demand for rescue medication.