Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone
Objectives
The objective was to test the hypothesis that buy oxycodone /acetaminophen provides superior analgesia to hydrocodone/acetaminophen for treating acute extremity pain following emergency department (ED) discharge. This manuscript underwent peer review in line with the standards of editorial integrity and publication ethics maintained by Academic Emergency Medicine. The reviewers have little financial connections. Reviewers’ peer-review process used for Academic Emergency Medicine is double-blinded. Therefore, the reviewers’ identities are not disclosed per the accepted standards of peer review in medical journals.
Conflicts of interest have been identified and addressed under Blackwell Futura Media’s Policy on Activity Disclosure and 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 differences between groups in improving the numerical scoring scale (NRS) scores for pain in the 2 hours following the most recent drug intake, which was determined via a telephone call within 24 hours following ED discharge. Other outcomes included a proportionate reduction in pain, comparable side-effect profile, and satisfaction of patients.
Results
An estimated 240 people were included in 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 level of satisfaction with analgesics and their effects was comparable.
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 decreased pain scores by about 50%. Blackwell Futura Media Services is the provider of this journal-based CME event for up to 1 AMA PRA Category 1 CreditTM. Physicians are only entitled to credit in proportion to the amount that they participated in the activity. Blackwell Futura Media Services has been accredited by the Accreditation Council for CME to offer continuing medical education to physicians.
Data Analysis
Descriptive statistics were calculated for all variables using mean that have Standard deviations (SDs) for normally distributed continuous data, medians with Interquartile Ranges (IQRs) for non-normally continuously distributed data and percentages for categorical and dichotomous data. We calculated the exact 95 per cent confidence intervals (CIs) about the differences between the means or the proportions of outcomes across 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 standard two-tailed beta of 0.05 and a power of 80 per cent to see an improvement in the range of 1.3 NRS units or more and a standard deviation of 3.0, We determined that 170 of the patients taking at minimum one dose of the prescription drug (85 for each of the groups) would require. Based on a previous study with a similar design, we established our calculations assuming that about 30 per cent of the patients have difficulty taking their medication according to the instructions. Therefore, we calculated that up to 120 patients from each group could be required to create an analyzable sample of at least 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 buy hydrocodone online /acetaminophen (5/325) for the treatment of acute musculoskeletal extremity pain in adults following ED discharge. Patients treated with either saw a substantial reduction in pain, as evidenced by pain scores that decreased more than 50% in both comparison groups. The decrease in pain was similar for both groups, showing a statistically insignificant variation in the pain reduction of just 0.4 NRS units (95 per cent 95% CI equals -0.2 up to 1.1 NRS units). This is well lower than the commonly acceptable minimum value of 1.3 NRS units required for the declaration as clinically significant. The study was sufficiently equipped to identify the presence of a clinical and statistically significant variation in pain scores if such a change was 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 hydrocodone/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.
