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?