CAN I.V. PARACETAMOL REDUCE THE OPIATE USAGE IN ACUTE FRACTURE NECK OF FEMUR PATIENTS? A DISTRICT GENERAL HOSPITAL EXPERIENCE

Abstract

The number of patients in the United Kingdom being admitted with Neck of Femur Fractures (NOF) is increasing each year. Primary first aid for these patients includes adequate analgesia. The commonest forms of analgesia are opioids and in some units regional blockade. However, both have limitations. Regional block is skill dependent while opiates are known to have many side effects.

Paracetamol is an analgesia that is safe and has an excellent side-effect profile within standard doses. Intravenous paracetamol has a far higher predictable bio-availibilty than oral, within standard dosage. This study is to assess the suitability of using intravenous Paracetamol as an alternative.

Method: Prospective study: a change in protocol resulted in all NOF’s admitted under the care of the senior author being prescribed regular intra-venous paracetamol within standard dosage. PRN opioids were available for breakthrough pain. NOF’s admitted under the care of other consultants remained on the established protocol. Opioid usage and pain scores (scale 0–10) were measured.

Results: results of 72 patients were collected, 44 in intravenous paracetamol group and 28 in the control group, having regular opiates and oral paracetamol. There is a 65% reduction in opiate usage in the intravenous paracetamol group (P value= 0.015). There is only a 0.5 difference in average pain score between the two groups (P value= 0.173).

Conclusion: The use of regular intra-venous paracetamol results in a significant reduction in the need for opioid analgesia. The pain relief within this group was comparable to that in the control group. The side-effects of opioids are dose dependent, a reduction in their usage therefore improves both pre and post-operative morbidity by reducing the side effects. A simple change in analgesia protocol to a safer, more predictive agent can result in an improved pre/postoperative period.