{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:37:06Z","timestamp":1760027826998},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,4]],"date-time":"2019-02-04T00:00:00Z","timestamp":1549238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) patients with acute pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a single\u2010blind, randomized, prospective study conducted in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol\/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> stay. The secondary outcome included patient satisfaction, <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> length of stay, and percentage of patients discharged from the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> with a VAS score of &lt;30.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol\/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> pain scores. Rescue morphine was significantly decreased in the tramadol\/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.03). Patient satisfaction was higher in the tramadol\/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> score of &lt;30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol\/acetaminophen combination group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01 between the acetaminophen group and tramadol\/acetaminophen combination group). The <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> length of stay was 60\u00a0minutes for the acetaminophen group and tramadol\/acetaminophen combination group and 71\u00a0minutes for the placebo group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Oral tramadol\/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s with an aim of similar benefits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12736","type":"journal-article","created":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T19:10:11Z","timestamp":1539198611000},"page":"275-282","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen\/Tramadol Combination in Acute Pain"],"prefix":"10.1111","volume":"19","author":[{"given":"Wahid","family":"Bouida","sequence":"first","affiliation":[{"name":"Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia"},{"name":"Research Laboratory LR12SP18 University of Monastir Monastir 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Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamdi","family":"Boubaker","sequence":"additional","affiliation":[{"name":"Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia"},{"name":"Research Laboratory LR12SP18 University of Monastir Monastir Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Habib","family":"Grissa","sequence":"additional","affiliation":[{"name":"Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia"},{"name":"Research Laboratory LR12SP18 University of Monastir Monastir Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma","family":"Zorgati","sequence":"additional","affiliation":[{"name":"Emergency Department Sahloul University Hospital Sousse Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Methamem","sequence":"additional","affiliation":[{"name":"Emergency Department Farhat Hached University 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