Objectives
The objective was to test the hypothesis that oxycodone/acetaminophen provides superior analgesia to buy hydrocodone acetaminophen for treating acute extremity pain following emergency department (ED) discharge. The article was peer reviewed to ensure compliance with the requirements of integrity in the editorial process and publication ethics as regulated through Academic Emergency Medicine. Reviewers have no financial relationships. Reviewers’ peer review process to evaluate Academic Emergency Medicine is double-blinded. This means that reviewers’ identities cannot be divulged as per the accepted guidelines of peer review in medical journals.
Conflicts of interests have been identified and addressed in Blackwell Futura Media’s policy on Disclosure of Activity as well as Conflicts of Interest.
Methods
This was a prospective, randomized, double-masked clinical trial of nonelderly adult ED patients with acute musculoskeletal extremity pain, randomly allocated at discharge to receive oxycodone/acetaminophen (5 mg/325 mg) or hydrocodone/acetaminophen (5 mg/325 mg). The primary outcome was the differences between groups in enhancing the numeric score scale (NRS) scores for pain during the two days following the most recent dosage, which was assessed via a phone contact within the first 24 hours of ED discharge. Additional outcomes were a significant reduction in pain, a similar to the side-effects profile, and satisfaction of patients.
Results
A total of 240 patients were taken into the. The final sample consisted of 220 patients, 107 randomly allocated to oxycodone/acetaminophen and 113 to hydrocodone/acetaminophen. At 24 hours after ED discharge, the mean NRS pain scores before the most recent dose of outpatient pain medication were 7.8 and 7.9 in the oxycodone/acetaminophen and hydrocodone/acetaminophen groups, respectively. The mean decreases in pain scores over 2 hours were 4.4 NRS units in the oxycodone/acetaminophen group versus 4.0 NRS units in the hydrocodone/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval = -0.2 to 1.1 NRS units). The degree of satisfaction in the use of painkillers and its effects were similar.
Conclusions
This study design could not detect a clinically or statistically significant difference in analgesic efficacy between oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (5 mg/325 mg) for the treatment of acute musculoskeletal extremity pain in adults following ED discharge. Both opioids reduced pain scores by approximately 50 percent. Blackwell Futura Media Services is the author the journal-based CME event that can earn up to AMA PRA category 1 credit. Physicians only have the right to credits in proportion to the amount they have participated in the event. Blackwell Futura Media Services has been approved with the Accreditation Council for CME to provide continuing medical education to doctors.
Data Analysis
Descriptive statistics were computed for every variable using mean values with Standard Deviations (SDs) in the case of normally distributed continuous data. Medians are calculated that have interquartile Ranges (IQRs) in the case of data that are not normally distributed continuously along with percentages for categorical as well as dichrotomous data. We determined the exact 95 percent Confidence intervals (CIs) on the variances between the means or proportions of outcomes for both groups.
To test the primary hypothesis that oxycodone/acetaminophen (5/325) would provide clinically superior pain relief compared to hydrocodone/acetaminophen (5/325), we used the previously validated minimum clinically significant difference of 1.3 NRS units as the most minor quantitative improvement in pain score worth detecting. With a 2T beta 0.05 and an ability of 80 percent to observe an improvement within between 1.3 NRS units or more, and an average deviation of 3.0 We found that 170 patients who took at least one dose of the prescribed medication (85 for each group) required. Based on an earlier study of similar design We formulated our calculations using the assumption that 30% of patients are having difficulty taking their medication in accordance with the prescription. We calculated that as many as 120 individuals from each of the groups might be needed to form an analyzable group of at minimum 85 patients.
Discussion
The results of this randomized, double-anonymized clinical trial suggest that there are no clinically or statistically significant differences in analgesic efficacy between oxycodone/acetaminophen (5/325) and hydrocodone/acetaminophen (5/325) for the treatment of acute musculoskeletal extremity pain in adults following ED discharge. Patients treated with either experienced a significant decrease in pain as demonstrated by the decrease in pain scores of over 50 percent in both groups of comparison. The reduction in pain was the same in both groups, with an insignificant statistical difference in the reduction in pain of only 0.4 NRS units (95 percent 95% CI is -0.2 or 1.1 NRS units). This is significantly less than the accepted minimum for 1.3 NRS units required for the recognition of a clinically significant. The study was adequately equipped to determine the existence of a clinically and statistically significant variance in pain scores, if changes were observed.
Our results led to the exact inference as the previous small ED study in that neither provides evidence of a difference in the effectiveness of the two analgesics despite a more significant decrease in pain in the patients given oxycodone/acetaminophen in the previous study than those who received buy hydrocodone online /acetaminophen that is considered minimally clinically significant. Similarly, a survey of dental pain following extraction of impacted third molars that compared oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (7.5 mg/500 mg) did not find sizeable or statistically significant differences in pain intensity or pain relief summed over 6 hours following a single dose of each combination.