comparison of efficacy of intravenous paracetamol and dexketoprofen for acute traumatic musculoskeletal pain

Conditions: Musculoskeletal Pain

Summary: * currently, paracetamol and nonsteroidal antiinflammatory drugs are widely used by emergency physicians in turkey for the treatment of patients with acute traumatic musculoskeletal pain. * the objective of the study is compare the efficacy of intravenous dexketoprofen with paracetamol in the treatment of acute traumatic musculoskeletal pain.

* this is the randomized double blinded clinical trial to compare the efficacy of these two drugs in this clinical setting. * a randomized clinical trial was conducted in the emergency department (ed) of pamukkale university medical faculty hospital * study personnel (emergency physicians and nurses) were trained before the study. * when intravenous drugs (paracetamol, dexketoprofen) was being recommended, an eligibility checklist was completed by the attending physician. * if there were no exclusion criteria, written informed consent was obtained and baseline information, including initial acute traumatic musculoskeletal pain severity ratings with visual analog scale (vas) were recorded. * the need for identification and enrollment of participants by staff with conflicting work pressures resulted in recruitment of a convenience sample of patients. * all patients eligible for the study were randomized to one of two groups: first group: 1000 mg of paracetamol ( perfalgan 10mg/ml solutionbristol-myers squibb_uk) intravenous (iv) was given 100 patients, second group: dexketoprofen 50 mg ( arveles ampoule -ufsa- istanbul) intravenous (iv) was given 100 patients which determined to be applied as a group. drug packs prepared in 150 ml serum physiology were numbered by an independent nurse, who not involved in the study. * drugs were prepared according to the computer-generated random number sequence to assign treatment allocations * the allocation list was kept by the emergency nurse. patients received the paracetamol, dexketoprofen medication schemes according to their random allocations. * after enrollment and recording of baseline information, the next numbered study drug pack was obtained, and administered intravenously. * randomization was achieved by using computer software to generate random numbers. during the intervention, participants were monitored by an oxygen saturation (spo2) monitor, an automatic sphygmomanometer (blood pressure), and a rhythm monitor (heart rate and rhythms) * one researcher blinded to patient allocation observed the whole procedure and recorded the acute non-traumatic musculoskeletal pain scores. * patients in both groups received two types of medication in a similar manner, thus ensuring double blind. * acute traumatic musculoskeletal pain scores were recorded at 0, 15, 30 and 60 min on a vas of 1 to 10 * rescue medication (fentanyl 1mcg/kg) was given intravenous to patients if pain vas scores ≥ 5 in sixty minutes after study drug administration. * all other medications required during the study also were recorded. * during the study, pulse rate, systolic blood pressure, diastolic blood pressure, respiration rate and oxygen saturation (spo2) were recorded at baseline (0 min), 15, 30, and 60 min.

Eligibility criteria:
inclusion criteria: * patients were eligible for inclusion if they were aged 18 years or older, 65 years or younger * isolated traumatic musculoskeletal pain * patients who agree to work and receive the approval * vas (visual analog scale) score\>5. exclusion criteria: * patients with severe liver, kidney,pulmonary and cardiac heartfailure * to be pregnancy and breast-feeding * have received analgesics in the last 6hours * patients of childbearing age who are not using a birth control method. * patients with neurological deficits * patients with sciatica and back pain * patients with cardiac chest pain * patients with chronic pain * patients with pre-existing dexketoprofen and paracetamol-induced gastrointestinal bleeding and perforation * patients with reflected pain * patients with neoplastic pain * patients with an allergy trait (paracetamol and dexketoprofen) * illiterates and patients with vision problems

Keywords: paracetamol dexketoprofen emergency department musculoskeletal pain