Can Acetaminophen Pretreatment Decrease the Pain Associated With Closed Nasal Bone Reduction? A Triple-Blind Randomized Clinical Trial

Abstract

<h3>Purpose</h3> Nasal bone fracture is a common maxillofacial injury, which is usually managed under local anesthesia because it is fast and effective but painful. We designed this study to see if pre-emptive analgesia with acetaminophen can reduce the pain associated with nasal bone reduction under local anesthesia. <h3>Patients and Methods</h3> This was a triple-blind, randomized clinical trial. Our sample was patients with nose fracture (eligible for closed reduction) who presented to our nasal fracture clinic and they were divided into 2 arms. Medication was randomly delivered via packages, and the surgeon, patients, and data analyzer were all blind to the intervention. Demographic data along with the visual analog scale pain scores (1 to 10 score from least to most severe pain) during local anesthesia, during reduction, and 24 hours after reduction were recorded, then analyzed using χ², nonparametric Mann-Whitney test, and correlation analysis. <h3>Results</h3> One hundred participants were divided into 2 arms (placebo or acetaminophen 500-mg tablet 45 minutes before reduction). The patients were mostly men (74%), and the most common mechanism was involvement in a fight (30%). Pain scores, as well as surgeon satisfaction analysis, returned no statistical difference between the 2 groups. Correlation analysis was performed, and the only factor for pain severity during reduction was the number of tries needed. <h3>Conclusions</h3> Acetaminophen pretreatment did not add analgesia any more than that of placebo. Its use before reduction of nasal bone fracture is not justified.