Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Am J Emerg Med. 2021 Jan;39:1-5. doi: 10.1016/j.ajem.2020.01.049. Epub 2020 Jan 28.
Pain in the Emergency Department is common and is frequently treated with opioids. Due to the opioid epidemic, it is clinically helpful to decrease opioid usage. The purpose of this study was to evaluate opioid requirement in Emergency Department patients with painful conditions who receive intravenous acetaminophen.
In this prospective cohort study, patients aged 18 years and older and treated with opioids in the acute phase were included. Patients receiving additional intravenous acetaminophen were compared to patients who did not. Primary outcome was opioid requirement, measured in Morphine Equivalent Units (MEU) during Emergency Department stay. Secondary outcomes were opioid requirement after discharge; decrease in pain scores; occurrence of adverse events and patient satisfaction.
A total of 116 patients were included of whom 76 received intravenous acetaminophen. Opioid consumption in the acute phase was not significantly different (p=0.53) between patients receiving (10.0 MEU (IQR 7.5; 15.0)) and those not receiving acetaminophen: 10.0 MEU (IQR 7.1; 15.0). After discharge these numbers were 15.0 MEU (IQR 7.5; 30.0) versus 30.0 MEU (IQR 15.0; 43.8), respectively (p=0.059). In both groups median NRS pain scores decreased from 9.0 to 4.0 and >80% of patients were satisfied regarding pain treatment. Nine minor adverse events were recorded, equally divided among the groups.
The additional use of intravenous acetaminophen did not decrease opioid requirement in adult patients with acute pain during Emergency Department stay. There was a trend towards decreased opioid requirement during 24 h after discharge.
急诊科的疼痛很常见，常使用阿片类药物进行治疗。由于阿片类药物流行，减少阿片类药物的使用在临床上是有帮助的。本研究的目的是评估接受静脉注射对乙酰氨基酚的急诊科疼痛患者的阿片类药物需求。
在这项前瞻性队列研究中，纳入了年龄在 18 岁及以上且在急性期接受阿片类药物治疗的患者。将接受额外静脉注射对乙酰氨基酚的患者与未接受该治疗的患者进行比较。主要结局是在急诊科住院期间以吗啡等效单位（MEU）衡量的阿片类药物需求。次要结局是出院后的阿片类药物需求；疼痛评分的降低；不良事件的发生和患者满意度。
共纳入 116 例患者，其中 76 例接受了静脉注射对乙酰氨基酚。接受（10.0 MEU（IQR 7.5；15.0））和未接受对乙酰氨基酚的患者在急性期的阿片类药物消耗无显著差异（p=0.53）：10.0 MEU（IQR 7.1；15.0）。出院后这些数字分别为 15.0 MEU（IQR 7.5；30.0）与 30.0 MEU（IQR 15.0；43.8）（p=0.059）。在两组中，NRS 疼痛评分中位数均从 9.0 降至 4.0，>80%的患者对疼痛治疗表示满意。记录了 9 例轻微不良事件，两组各有 4 例。
在急诊科急性疼痛的成年患者中，额外使用静脉注射对乙酰氨基酚并不能减少阿片类药物的需求。出院后 24 小时内阿片类药物需求有减少的趋势。
