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In a German study comparing one EMS jurisdiction which used IV paracetamol (acetaminophen) in combination with nalbuphine (Nubian, opiate agonist/antagonist) to another jurisdiction which used piritramide (synthetic opioid similar to fentanyl) for prehospital traumatic pain, the combination worked better to decrease pain on a numerical scale. There were no differences in typical safety measures.
The use of an antagonist/agonist theoretically could precipitate withdrawal in non-opiate naive patients and could influence in hospital analgesic choices. The literature on this is mixed.
This study offers further evidence of the efficacy of multi-modal pain control, the feasibility of paramedics using IV paracetamol and the possibility of using rapid onset opioid agonist/antagonist in the prehospital setting.
References
Lohmann, J., Deicke, M., Deslandes, M. et al. Prehospital analgesia for trauma-related pain by paramedics: a comparative retrospective observational study of paracetamol, nalbuphine plus paracetamol, and piritramide. Scand J Trauma Resusc Emerg Med 33, 152 (2025). https://doi.org/10.1186/s13049-025-01470-8