Hyoscine butylbromide and acetaminophen have comparable effects for pediatric non-specific colicky abdominal pain

1. Hyoscine butylbromide and acetaminophen have comparable and significant analgesic effects for pediatric non-specific colicky abdominal pain.

Evidence Rating Level: 1 (Excellent)

Cases of pediatric abdominal pain are a daily occurrence in hospital emergency wards. However, current analgesic recommendations for pediatric abdominal pain are not being adhered to, with two-thirds of patients not receiving any analgesia, and approximately half still experiencing pain post-discharge. A potential factor for this is the lack of analgesic guidelines for non-specific abdominal pain, which comprises two-thirds of abdominal pain cases. Acetaminophen is widely used to treat a variety of painful conditions, but there is insufficient data to demonstrate its effectiveness for abdominal pain, Hyoscine butylbromide (HBB) is an oral antispasmodic medication that has some studies supporting its effectiveness. The current study was a randomized controlled trial to determine whether HBB had superior pain-relieving abilities compared to acetaminophen, for pediatric non-specific colicky abdominal pain. The study population consisted of 236 children ages 8-17 (mean±SD age was 12.4±3), with 120 patients given 10 mg of HBB and 116 given 15 mg/kg of acetaminophen. Each patient presented to a hospital in London, Ontario with a self-reported pain score of at least 40 mm on a 100 mm visual analogue scale (mean pain score was 60±18 mm for HBB, and 62±17 mm for acetaminophen). The primary outcome was pain score 80 minutes after administering the analgesic, to reflect the drugs’ peak action. Overall, the results showed no difference in pain score: For HBB, the mean score was 29±26 mm, while for acetaminophen, it was 30±29 mm. The adjusted difference between the groups was 1 mm (95% CI -7 to 7 mm). Furthermore, no significant differences were found for requirement of emergency analgesia, nor for adverse events and complications. In conclusion, HBB is not superior to acetaminophen for non-specific colicky pediatric abdominal pain, although both forms of analgesia can produce a clinically significant reduction in pain.

Click to read the study in CMAJ

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