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Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized
Naveen Poonai1, Kriti Kumar2, Kamary Coriolano2
1Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta. naveen.poonai@lhsc.on.ca.
Insights
Hyoscine butylbromide and acetaminophen provide similar pain relief for children with abdominal pain. Neither medication was found to be superior, offering effective options for emergency department care.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Pain Management
Background:
- Many children with abdominal pain in emergency departments do not receive adequate pain relief.
- There is a need to evaluate effective analgesia options for pediatric abdominal pain.
Purpose of the Study:
- To compare the efficacy of hyoscine butylbromide versus acetaminophen in treating nonspecific colicky abdominal pain in children.
- To determine if hyoscine butylbromide offers superior pain reduction compared to acetaminophen.
Main Methods:
- A randomized trial involving children aged 8-17 years with nonspecific colicky abdominal pain.
- Participants received either oral hyoscine butylbromide (10 mg) or oral acetaminophen (15 mg/kg, max 975 mg).
- Pain was assessed using a 100 mm visual analogue scale at 80 minutes; secondary outcomes included rescue analgesia and adverse effects.
Main Results:
- No significant difference in mean visual analogue scale pain scores at 80 minutes between hyoscine butylbromide (29 mm) and acetaminophen (30 mm).
- Similar rates of rescue analgesia administration and adverse effects were observed between the two groups.
- Both medications demonstrated clinically important pain reduction, with no serious adverse events reported.
Conclusions:
- Hyoscine butylbromide is not superior to acetaminophen for managing nonspecific colicky abdominal pain in children presenting to the emergency department.
- Both hyoscine butylbromide and acetaminophen are effective and can be considered for pain management in this pediatric population.
- The study provides evidence supporting the use of either agent for clinically important pain reduction.
Background:
Less than two-thirds of children with abdominal pain in the emergency department receive analgesia. We sought to determine whether hyoscine butylbromide was superior to acetaminophen for children with nonspecific colicky abdominal pain.
Methods:
We randomly allocated children aged 8-17 years with nonspecific colicky abdominal pain who presented to the pediatric emergency department of London Health Sciences Centre, London, Ontario to receive hyoscine butylbromide, 10 mg given orally, or acetaminophen, 15 mg/kg given orally (maximum 975 mg). We considered the minimal clinically important difference for the primary outcome (self-reported pain at 80 min) to be 13 mm on a 100 mm visual analogue scale. Secondary outcomes included administration of rescue analgesia, adverse effects and pain score less than 30 mm at 80 minutes.
Results:
A total of 236 participants (120 in the hyoscine butylbromide group and 116 in the acetaminophen group) were included in the trial. The mean visual analogue scale scores at 80 minutes were 29 mm (standard deviation [SD] 26 mm) and 30 mm (SD 29 mm) with hyoscine butylbromide and acetaminophen, respectively (adjusted difference 1, 95% confidence interval -7 to 7). Rescue analgesia was administered to 4 participants (3.3%) in the hyoscine butylbromide group and 1 participant (0.9%) in the acetaminophen groups (p = 0.2). We found no significant differences in rates of adverse effects between hyoscine butylbromide (32/116 [27.6%]) and acetaminophen (28/115 [24.3]) (p = 0.5); no serious adverse effects were observed. The proportion with a pain score less than 30 mm at 80 minutes was 66 (55.0%) with hyoscine butylbromide and 63 (54.3%) with acetaminophen (p = 0.9).
Interpretation:
Hyoscine butylbromide was not superior to acetaminophen in this setting. Both agents were associated with clinically important pain reduction, and either can be considered for children presenting to the emergency department with nonspecific colicky abdominal pain. Trial registration: Clinicaltrials.gov, no. NCT02582307.
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