Can acetaminophen pretreatment decrease the pain associated with closed nasal bone reduction? A triple-blind randomized clinical trial

Abstract Introduction 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. Methods This was a triple-blind, randomized clinical trial. Our sample were patients with nose fracture (eligible for closed reduction) who presented to our nasal fracture clinic and were divided into two 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 (VAS) pain scores (1-10 score from least to most severe pain) during local anesthesia, during reduction and 24 hours after reduction were recorded, then analyzed using chi-square, non-parametric Mann-Whitney test and correlation analysis. Results One hundred participants divided into two 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 two groups. Correlation analysis was done and the only factor for pain severity during reduction was the number of tries needed. Conclusions Acetaminophen pre-treatment did not add analgesia any more than that of placebo. Its use before reduction of nasal bone fracture is not justified.