Oxycodone as a Component of Multimodal Analgesia Post-Caesarean Section in Australia and New Zealand

Oral oxycodone plus intravenous acetaminophen versus intravenous morphine sulfate in acute bone fracture pain control: a double-blind placebo-controlled randomized clinical trial

OBJECTIVES

Bone fracture is a common cause of acute pain in emergency and orthopedics departments. Targeting the multifaceted mechanisms of pain with combinations of multiple analgesics (multimodal analgesia) can increase the pain control efforts efficacy and decrease the adverse effects of each medication.

METHODS

One hundred and fifty-three patients with acute bone fracture were randomly allocated to two groups receiving intravenous morphine sulfate (74 patients) or oral oxycodone plus intravenous acetaminophen (79 patients). Pain scores and drugs' adverse effects were assessed 10, 30 and 60 min after treatment.

RESULTS

Pain scores were similar between groups before, 30 and 60 min after medication but patients in morphine sulfate group experienced less pain 10 min after medication. Eight (10.8%) patients in morphine sulfate group and 26 (32.9%) patients in acetaminophen/oxycodone group experienced nausea that was statistically significant higher (P value = 0.001). Itching was seen in 12 (15.1%) patients of acetaminophen/oxycodone group and three (4.0%) patients of patients in morphine sulfate group (P value = 0.02).

CONCLUSION

Intravenous acetaminophen plus oral oxycodone is as effective as intravenous morphine sulfate in acute pain control in emergency department but with a less desirable safety profile.

Two hundred days of nurse practitioner prescribing and role development: a case study report from a hospital-based acute pain management team

Purpose. This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management. Healthcare setting. The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice. Method of data collection. Data were conveniently collected by the NP on prescription and service provision over 200 working days. Main findings. Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics. Principal conclusions. These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required. What is known about the topic? There is little published information on the development of the Nurse Practitioner (NP) role in acute pain services in Australia or overseas. The acute pain role is a new development in Australia and so previous descriptions of NP practice have focussed on other specialty areas such as Emergency or Mental Health. What does this paper add? This report demonstrates positive and safe client outcomes as a result of a NP role in acute pain management. More importantly, it may contribute to accumulating evidence that NPs are safe prescribers of opioids and other analgesics in acute settings. What are the implications for practitioners? Novice NPs and Candidates practising in this specialty need to use this information as support for their own role development and implementation in other acute pain services in Australia.