Journal Club – 5th March 2018

Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial 

Thanks for the great turn out especially from ACP’s and Nurses (come on docs we are being out shone!!!) – and a really insightful look at the paper.

Reported Result

IV paracetamol shows no significant benefit over oral paracetamol in pain control.

Our Opinion

Overall: a very good paper that should influence our practice (with some caveats to consider)

Issues highlighted

  • Internal validity
    • Small Study: didn’t quite reach its power calculation in one group (40 vs 44)
    • Patient characteristics: more men in oral paracetamol group (felt this may make oral para look worse as men are renowned Wusses)
    • Loss of data: initially verbal or written, changed to written later by ethics committee
      • Did this skew the population who were tested?
  • External validity
    • Population: all had had 5mg morphine prior to the paracetamol
    • Single site: one hospital in Australia
  • Results: were they testing too early? (started at 15 min  unto 240min)
  • Discussion
    • What is the psychological effect of IV over Oral medication (esp. paracetamol)
      • How would this effect implementing this data?
      • How much weight should we put on the psychological perception of effectiveness?
      • Would explaining to patients really work for all?

 

Leave a Reply

Your email address will not be published. Required fields are marked *

nine + 7 =

This site uses Akismet to reduce spam. Learn how your comment data is processed.