scholarly journals LO049: Ibuprofen or oxycodone? An observational cohort study of post-emergency department discharge management of children’s fracture pain

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S47-S47 ◽  
Author(s):  
S. Ali ◽  
A.L. Drendel ◽  
R.J. Rosychuk ◽  
S. Le May ◽  
P. McGrath ◽  
...  
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Treatment ◽  
School Attendance ◽  
Pain Scale ◽  
Post Injury ◽  
Maximum Pain ◽  
Emergency Department Discharge ◽  
Fracture Types

Introduction: Pediatric fracture pain is under-treated both in the emergency department (ED) and after discharge. Oral opioids and ibuprofen are amongst the top medications used to treat this pain. This study describes the post ED discharge effectiveness and safety of ibuprofen and oxycodone. Methods: A prospective cohort observational study was conducted at the Stollery Children’s Hospital (Edmonton, Alberta) from June 2010 to July 2014. Children aged 4-16 years, with an acute fracture, who were being discharged home with either ibuprofen (Ibu) or oxycodone (Oxy) for pain management were eligible for recruitment. Patients were contacted daily for three days, and at 2 and 6 weeks post-injury. Information regarding medication use, pain levels (with the Faces Pain Scale, Revised), adjuvant therapies, adverse events, and side effects and follow up was collected. Results: A total of 329 children (n=112 Oxy, n= 217 Ibu) were included. Mean age was 10.4 years (Ibu), and 12.3 years (Oxy); 68% (n=223) were male. Fracture types included forearm/wrist (47%,n=154), lower leg/ankle (14%,n=46), shoulder/clavicle (13%,n=42), and upper arm/elbow (12%,n=39). Reductions were performed in 34% of cases (n=113), while 9% (n=29) had buckle fractures. Children receiving Oxy had their eating, sleeping, play, and school attendance affected more than those receiving Ibu. More children receiving Oxy (81%, 91/112) experienced an adverse effect than those receiving Ibu (61%, 129/213) (p=0.0002); abdominal pain, dizziness, drowsiness, nausea, and vomiting were most prominent. The change in pain score (maximum pain - post-treatment pain) for Day 1 was 3.79 for Oxy and 3.61 Ibu; Day 2 was 3.68 Oxy and 3.55 Ibu; Day 3 was 3.34 Oxy and 3.66 Ibu. On Day 1, 59% (66/112) of Oxy cohort patients used other medication(s) for their pain treatment; 19% (41/213) did the same in the Ibu cohort. Conclusion: Ibuprofen and oxycodone provide similar pain relief for children with post-Ed discharge fracture pain. Oxycodone has greater impact on activities of daily living, side effects, and use of other medications to relieve pain. Oxycodone does not appear to confer any benefit over ibuprofen for pain relief, and given its negative side effect profile, this study suggests that ibuprofen is the better option. Further research is needed to determine the best combination treatment for fracture pain for children.

scholarly journals Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture Patients

2007 ◽  
Vol 106 (4) ◽  
pp. 773-778 ◽  
Author(s):  
Nicolai B. Foss ◽  
Billy B. Kristensen ◽  
Morten Bundgaard ◽  
Mikkel Bak ◽  
Christian Heiring ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Pain Relief ◽  
Intramuscular Injection ◽  
Pain Treatment ◽  
Isotonic Saline ◽  
Interquartile Range ◽  
Morphine Group ◽  
Double Blind ◽  
Maximum Pain

Background Hip fracture patients are in severe pain upon arrival at the emergency department. Pain treatment is traditionally based on systemic opioids. No study has examined the effect of fascia iliaca compartment blockade (FICB) in acute hip fracture pain management within a double-blind, randomized setup. Methods Forty-eight patients with suspected hip fracture were included immediately after arrival in the emergency department, before x-ray confirmation of their fracture. Included patients were randomly assigned to two groups of 24. In the FICB group, the patients received an FICB with 1.0% mepivacaine and a placebo intramuscular injection of isotonic saline. In the morphine group, the patients received a placebo FICB with 0.9% saline and an intramuscular injection of 0.1 mg/kg morphine. Patients received intravenous rescue morphine when necessary. Results Maximum pain relief was superior in the FICB group both at rest (P < 0.01) and on movement (P = 0.02). The median total morphine consumption was 0 mg (interquartile range, 0-0 mg) in the FICB group and 6 mg (interquartile range, 5-7 mg) in the morphine group (P < 0.01). More patients (P = 0.05) were sedated in the morphine group at 180 min after block placement as compared with the FICB group. Conclusion Pain relief was superior at all times and at all measurements in the FICB group. The study supports the use of FICB in acute management of hip fracture pain because it is an effective, easily learned procedure that also may reduce opioid side effects in this fragile, elderly group of patients.

scholarly journals Evaluation of the use of analgesics for blunt thoracic trauma in the accident and emergency department

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Riccardo Valli ◽  
Carlo Maino ◽  
Massimiliano Etteri ◽  
Marta Maj
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Pain Relief ◽  
Thoracic Trauma ◽  
Pain Treatment ◽  
Blunt Thoracic Trauma ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Clinical Conditions

Proper pain management is an essential process when dealing with a patient suffering from blunt thoracic trauma, because it blocks the vicious circle that leads to the development of trauma related complications. This retrospective study deals with the use of pain killers administered in the Accidents and Emergency Department (ED) and prescribed at discharge to patients suffering from blunt thoracic trauma. The analysis confirms the existence of oligoanalgesia, that is an inadequate pain treatment, in clinical practice. Out of 214 patients involved in the study, only 78 patients (36.4%) received at least one pain killing drug during their stay in the ED. More than half of the patients discharged within 24 hours of admittance to the ED received no detailed advice about pain relief therapy and 8% of them (11 out of 136) returned to the ED within 15 days for persisting symptoms. Four were eventually admitted to hospital due to deterioration in their clinical conditions.

scholarly journals Effectiveness Study of Moxibustion on Pain Relief in Primary Dysmenorrhea: Study Protocol of a Randomized Controlled Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Jie Yang ◽  
Jiao Chen ◽  
Lixing Lao ◽  
Mingxiao Yang ◽  
JianPing Chen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Controlled Trial ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Treatment ◽  
Controlled Trial ◽  
Effectiveness Study ◽  
Primary Dysmenorrhea ◽  
Randomized Controlled ◽  
Menstruating Women

Dysmenorrhea is a prevalent problem in menstruating women. As a nonpharmacologic and free of relevant side effects intervention, moxibustion is considered as a safe treatment and has long been recommended for dysmenorrhea in China. However, the exact effects of moxibustion in PD have not been fully understood. Therefore we designed this random clinical trial aiming to (1) investigate whether moxibustion is safe and effective for pain relief in primary dysmenorrhea when compared to conventional pain-killers and (2) assess the acceptability and side effects associated with moxibustion. The results of this trial will contribute to a better understanding of the different effects of moxibustion in pain relief in primary dysmenorrhea when compared to conventional pharmacologic pain treatment.

Sufentanil Citrate and Morphine/Bupivacaine as Alternative Agents in Chronic Epidural Infusions for Intractable Non-Cancer Pain

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Samuel J. Hassenbusch ◽  
Michael D. Stanton-Hicks ◽  
James Soukup ◽  
Edward C. Covington ◽  
Mary Beth Boland
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Intrathecal Morphine ◽  
Compression Fracture ◽  
Pain Scale ◽  
Infusion Pumps ◽  
Pain Scales ◽  
Number Of Patients ◽  
Alternative Drug ◽  
Effective Pain Relief

Abstract Intraspinal narcotic (usually intrathecal morphine) infusions with implanted pumps are increasingly used in patients with intractable chronic pain not caused by cancer. In some patients, pain control is difficult with infusions of morphine. Seven patients with diagnoses of arachnoiditis, epidural scarring, and/or vertebral body compression fracture were treated with alternative solutions in an epidural route. For maximal flexibility, Medtronic implanted programmable infusion pumps with catheters to T6-T10 were used, and pain was monitored by verbal pain scales. In three patients, epidural infusions of morphine in 0.5% bupivacaine (MS-MARC) resulted in little or no pain relief without significant side effects (e.g., headache, nausea, or vomiting). In these same patients, epidural infusions of sufentanil citrate resulted in pain scale reductions of 92%, 82%, and 40%, respectively, with no side effects. Four other patients found more effective pain relief when switched from initial sufentanil citrate infusions to MS-MARC. Pain scale reductions (with no side effects) were 92%, 76%, 59%, and 47% in these patients. Pain relief and minimal side effects with sufentanil citrate is theorized to result from its higher lipophilicity promoting local transdural diffusion to spinal cord and limiting upward diffusion to the brain stem. Sufentanil citrate is also advantageous for programmable pumps because it is 100 times more potent than morphine and therefore allows longer pump refill times and higher infusion doses. Although this study was done on a limited number of patients, sufentanil citrate and MS-MARC in epidural infusions using programmable infusion pumps for non-cancer patients provide significant alternative drug combinations and routes. (Neurosurgery 29:76-82, 1991)

scholarly journals A proposed plan for personalized radiosurgery in patients with trigeminal neuralgia

2018 ◽  
Vol 128 (2) ◽  
pp. 452-459 ◽  
Author(s):  
Seyed H. Mousavi ◽  
Ajay Niranjan ◽  
Berkcan Akpinar ◽  
Edward A. Monaco ◽  
Jonathan Cohen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Standard Dose ◽  
Target Volume ◽  
Pain Scale ◽  
Dose Selection ◽  
Sensory Dysfunction ◽  
Pain Status ◽  
Maximum Pain

OBJECTIVEDuring the last 25 years, more than 100,000 patients worldwide with trigeminal neuralgia (TN) have undergone stereotactic radiosurgery (SRS) with a standard dose of radiation. However, the radiobiological effect of radiation is determined by the amount of energy delivered to the tissue (integral dose [ID] = mean dose × target volume) and is directly associated with the nerve volume. Although the trigeminal nerve volume varies among patients with TN, the clinical impact of this variation in delivered energy is unknown. The objective of this study was to evaluate the effect of delivered ID on the outcome of TN radiosurgery.METHODSThe authors evaluated 155 patients with unilateral TN who had undergone SRS as their initial surgical management over a 13-year period. The authors measured the postganglionic ID within the SRS target and retrospectively stratified patients into 3 groups: low (< 1.4 mJ), medium (1.4–2.7 mJ), and high (> 2.7 mJ) ID. Clinical outcomes, which included pain status (scored using the Barrow Neurological Institute Pain Scale) and sensory dysfunction (scored using the Barrow Neurological Institute Numbness Scale), were evaluated at a median follow-up of 71 months.RESULTSPatients who were treated with a medium ID had superior pain relief either with or without medications (p = 0.006). In the medium ID group, the rates of complete pain relief without medications at 1, 3, and 6 years after SRS were 67%, 54%, and 33%, respectively, while the rates in the rest of the cohort were 55%, 36%, and 19%, respectively. Patients given a high ID had a higher rate of post-SRS trigeminal sensory deterioration (p < 0.0001). At 1, 3, and 6 years after SRS, the high ID group had an estimated rate for developing sensory dysfunction of 35%, 45%, and 50%, respectively, while the rates in patients receiving low and medium IDs were 3%, 4%, and 9%, respectively. The optimal clinical outcome (maximum pain relief and minimal trigeminal sensory dysfunction) was obtained in patients who had received a medium ID.CONCLUSIONSWith current dose selection methods, nerve volume affects long-term clinical outcomes in patients with TN who have undergone SRS. This study suggests that the prescribed SRS dose should be customized for each TN patient based on the nerve volume.

Intranasal Ketorolac for Acute Pain in Adult Emergency Department Patients

2021 ◽  
pp. 019394592110303
Author(s):  
Elizabeth Gaul ◽  
Tracy Barbour ◽  
Amy S. Nowacki ◽  
Sharon E. Mace
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Pain Relief ◽  
Acute Pain ◽  
Rating Scale ◽  
Rapid Onset ◽  
Numeric Rating Scale ◽  
Needlestick Injury ◽  
Interquartile Range ◽  
Numeric Rating

Pain is a common complaint in the emergency department. An alternative to opioids is desirable. Oral medications are not feasible with gastrointestinal disorders or NPO. Intravenous medications require skill and time. Intravenous/intramuscular medications are painful with potential needlestick injury. Intranasal medications have rapid onset, easy administration, do not need skilled providers, and no risk of needlestick injury. A total of 28 adults with acute pain (numeric rating scale ≥ 4) received intranasal ketorolac. Numeric rating scale decreased in all: 32% complete pain relief, median (interquartile range) decrease −5 (−6.8 to −4) ( p < .001). Pain relief onset was median [interquartile range] 5 (2.3, 15.0) min. Vital signs remained normal. There were no nasal mucosal changes, no complications. Minor side effects, mostly nasal burning, in 43%, resolved within 5 min. Patients and nurses were satisfied with intranasal ketorolac, and would use it again. Intranasal ketorolac had a rapid onset, was effective, safe, well tolerated with minor side effects that resolved quickly.

Side effects from opioids used for acute pain after emergency department discharge

2020 ◽  
Vol 38 (4) ◽  
pp. 695-701 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Alexis Cournoyer ◽  
Éric Piette ◽  
Judy Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Acute Pain ◽  
Emergency Department Discharge

scholarly journals ACUTE RENAL COLIC

2010 ◽  
Vol 17 (01) ◽  
pp. 59-63
Author(s):  
MUHAMMAD ALI NAQVI ◽  
Zl MIRZA
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Pain Relief ◽  
Diclofenac Sodium ◽  
Military Hospital ◽  
Rescue Analgesia ◽  
Quasi Experimental ◽  
Group A ◽  
Ureteric Colic ◽  
Group B

Objective: To compare the efficacy of Nelbuphine hydrochloride (opioid) and Diclofenac Sodium (NSAID) in management of Acuterenal pain. Design: Prospective non-randomized quasi experimental study. Setting: This study was conducted in Emergency department (ED)of Combined Military Hospital, Lahore. Period: From 1st April 2008 to 31 July 2009. Patients and Method: A Total of 100 patients presentingin emergency department with a clinical diagnosis of renal and Ureteric colic were studied. They were randomly divided in to equal andcomparable groups, Group A & B. Severity of pain was assessed using a Visual Analogue scale (VAS). Group A was treated with IntravenousNelbuphine 10mg and group B was given intramuscular Diclofenac Sodium 75mg. Assessment of Pain relief, both onset and complete responsewas assessed in both groups. In addition to the pain relief, side effects like Nausea, vomiting, respiratory depression, drowsiness and injectionsite pain were also assessed. Results: Nelbuphine was found significantly superior (p=0.05) to Diclofenac, both for time of onset of pain reliefand complete pain relief. Moreover less patients required rescue analgesia in Group A (p=0.05). Only one patient treated with Group A hadrespiratory depression which was statistically insignificant (p=0.05). There was a 3.5% increase in Nausea and vomiting in Nelbuphine treatedpatients. Conclusion: Nelbuphine is a safe and rapid acting Opioid with few side effects. It should be preferred over Diclofenac sodium intreatment of Acute Renal pain.

Intranasal sufentanil compared with a classic protocol for acute pain management in an emergency department: A prospective sequential study

Trauma ◽  
2021 ◽  
pp. 146040862110324
Author(s):  
Bernard Kreps ◽  
Stefano Malinverni ◽  
Emma Carles ◽  
Magali Bartiaux ◽  
Pierre Youatou Towo
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Intensity ◽  
Acute Pain ◽  
Visceral Pain ◽  
Intervention Group ◽  
Control Group ◽  
Sequential Study ◽  
Significant Difference

Introduction Pain is a frequent complaint in the emergency department and should be measured and treated according to the existing protocols. The intranasal route offers several advantages over the oral or intravenous routes. The aim of the study was to evaluate the efficacy and safety of intranasal sufentanil as the primary opioid for acute pain in the emergency department. Materials and methods This was a prospective open-label sequential study in patients who presented to the emergency department with severe non-visceral pain. The control group was treated according to the current standard of care including oral or intravenous opioids whereas the intervention group was treated according to a modified protocol, including intranasal sufentanil as the only opioid. Pain intensity was measured at different time points. The occurrence of side effects, the placement of intravenous lines and the need for additional analgesia were also recorded. Results Pain intensity in the two groups was not comparable at baseline (8.5; IQR 8–10 in the intervention group vs 7.9; IQR 7–9.4 in the control group; p = .026). However, the median reduction of the pain score was significantly larger in the intervention group compared to the control group after 15 minutes (2.5; IQR 1.2 – 4 vs 1.6; IQR 1–2.4; p = .005) and after 30 min (4; IQR 3–5.7 vs 3.1; IQR 2–4.4; p = .02). No significant difference in pain scores between the two groups was observed after 60 min from baseline. Conclusions Patients receiving intranasal sufentanil for severe pain achieved better pain relief at 15 min and 30 min compared to those receiving standard care. Vertigo, nausea, vomiting and diaphoresis were side effects more frequently observed in the sufentanil group. No differences in pain relief were observed after 30 and 60 min from baseline.

Butorphanol: A Double-Blind Comparison with Pentazocine in Post-Operative Patients with Moderate to Severe Pain

1976 ◽  
Vol 4 (4) ◽  
pp. 255-264 ◽  
Author(s):  
M S Gilbert ◽  
R S Forman ◽  
D S Moylan ◽  
F S Caruso
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Randomized Trial ◽  
Side Effect ◽  
Severe Pain ◽  
Weight Basis ◽  
Common Side Effect ◽  
Double Blind ◽  
Maximum Pain ◽  
Blind Comparison

A double-blind, randomized trial was conducted with 124 post-operative patients to compare the analgesic activity and possible side-effects of a new synthetic analgesic—butorphanol tartrate (1, 2, and 4 mg)—and pentazocine lactate (30 and 60 mg), administered intramuscularly. Butorphanol was determined to be 16 times more potent than pentazocine, on a weight basis. Both medications provided maximum pain relief within one hour after administration, and had comparable durations of action. Drowsiness was the most common side-effect, and it appeared to be dose-related in all test groups.

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