paracetamol vs caffeine vs codeine in the management of post traumatic pain in emergencies

Conditions: Acute Pain Due to Trauma

Summary: the purpose of this study is to: compare the effect of paracetamol alone against paracetamol+codeine association against the association of paracetamol + cafeine in the treatment of post-traumatic acute pain of the limbs.

at admission to the emergency department, patients with acute post-traumatic pain will be included, regardless of their initial nrs .these patients will receive the necessary care for their injury (icing, reduction, immobilization, local care, sutures), then went home with a medical prescription and an outpatient appointment . at discharge and after obtaining their signed consent . all patients included will be randomized according to a numerical randomization table ( assigned in a 1:1:1 ratio) into 3 groups ( as a treatment for their post traumatic pain at discharge for 7 days ) : * group 1: paracetamol group who will receive paracetamol ( 1000 mg) : one pill 3 times a day for 7 days . * group 2: paracetamol-codeine group who will receive an association of 500 mg of paracetamol and 30 mg of codeine : one pill twice a day for 7 days . * group 3: paracetamol-cafeine group who will receive an association of 500 mg of paracetamol and 65 mg of cafeine : one pill 3 times a day for 7 days . for all patients included in the study, demographic and clinical data will be collected by the physician or investigator and recorded on a pre-established form. the demographic data recorded on each patient's chart were as follows: age, sex, origin and personal pathological history: * hypertension. * diabetes. * respiratory insufficiency. * renal insufficiency. * liver failure. * allergy. and a clinical examination data: * pain intensity (nrs). * mechanism of trauma and site of injury. * other physical examination data: systolic blood pressure (sbp), heart rate (hr) and temperature. * nature of traumatic injury. * final diagnosis * injury severity score (iss). * nrs at discharge (at rest and on movement). patients included will be assessed at day 1 , day 2 , day 3 and day 7 after discharge from the emergency department by a telephone call. this evaluation will include : * nrs at rest and during movement * secondary use of another analgesic. * patient satisfaction assessed by likert scale, with 3 responses: * satisfied * moderately satisfied * not satisfied * side effects: epigastralgia, dizziness, somnolence, headache, nausea and/or vomiting, insomnia, constipation, palpitation, etc.

Eligibility criteria:
inclusion criteria: * age :18 years or older * patients presented to the emergency department with acute post-traumatic pain and residual pain at rest and/or on movement with a numerical pain rating scale (nrs) \> 3/10 on discharge. * they all signed a written consent form. exclusion criteria: * self-mutilation * severe acute trauma that may require hospitalization * open or complicated fracture requiring surgical management * regular use of analgesics * any known allergy to paracetamol, caffeine or codeine * asthma and acute/chronic respiratory insufficiency * severe renal insufficiency (creatinine cl\<30 ml/min) * pregnant/lactating women * hepatic cirrhosis. * refusal, incapacity or difficulties to consent or to communicate

Keywords: acute pain trauma paracetamol codeine cafeine