I've yet to be terribly impressed with the "new" pain control options available to clinicians these days. We've got tapentadol (Nucynta), which works just about as well as ibuprofen. We've got companies working on a purified hydrocodone derivative that's 10 times stronger and equally more dependence forming. And then we have intravenous paracetamol/acetaminophen.
So, it works. Studies, like this one, show it's reasonably effective and has a minimal side effect profile - at least compared to the mild incidence of nausea seen with IV morphine. It's slightly faster acting, achieves more reliable plasma levels than oral paracetamol/acetaminophen, and it's presumably as safe - although the safety of any intravenous drug is compromised due to extravasation risks and potential administration errors. Oral paracetamol/acetaminophen bills a patient a few dollars while IV administration bills around a hundred, and I continue to wonder whether these sorts of "innovations" are worthwhile advances in pain control outside of extremely narrow indications. I believe we now stock this and intravenous ibuprofen at our hospital - and goodness knows I've never seen anyone use them. While relief in suffering is undoubtedly one of our most important roles in healthcare, we have to weigh the few moments of physical suffering against the long-term consequences/suffering of the hospital bills that may be passed along to our patients.
Anyone have a favorable experience with these new non-narcotic medications?
"Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial"