Analgesie bei Traumapatienten in der Notfallmedizin

Häske, David; Böttiger, Bernd W.; Bouillon, Bertil; Fischer, Matthias; Gaier, Gernot; Gliwitzky, B.; Helm, Matthias; Hilbert-Carius, Peter; Hoßfeld, Björn; Schempf, Benjamin; Wafaisade, Arasch; Bernhard, Michaël

doi:10.1007/s00101-020-00735-4

Cited by 16 publications

(15 citation statements)

References 94 publications

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“…By now, besides the original trial for the authorization [28], methoxyflurane has been studied in further prospective, randomized trials from France, Italy and Spain, all carried out in in-hospital emergency departments [29][30][31]. However, it is not yet possible to make an assessment on prehospital use of methoxyflurane by paramedics in Europe [32].…”

Section: Introductionmentioning

confidence: 99%

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Trimmel

Egger²,

Doppler³

et al. 2022

BMC Emerg Med

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Background Pain relief in the prehospital setting is often insufficient, as the administration of potent intravenous analgesic drugs is mostly reserved to physicians. In Australia, inhaled methoxyflurane has been in routine use by paramedics for decades, but experience in Central European countries is lacking. Thus, we aimed to assess whether user friendliness and effectiveness of inhaled methoxyflurane as sole analgesic match the specific capabilities of local ground and air-based EMS systems in Austria. Methods Observational study in adult trauma patients (e.g. dislocations, fracture or low back pain following minor trauma) with moderate to severe pain (numeric rating scale [NRS] ≥4). Included patients received a Penthrop® inhaler containing 3 mL of methoxyflurane (maximum use 30 min). When pain relief was considered insufficient (NRS reduction < 3 after 10 min), intravenous analgesics were administered by an emergency physician. The primary endpoint was effectiveness of methoxyflurane as sole analgesic for transport of patients. Secondary endpoints were user friendliness (EMS personell), time to pain relief, vital parameters, side effects, and satisfaction of patients. Results Median numeric pain rating was 8.0 (7.0–8.0) in 109 patients. Sufficient analgesia (reduction of NRS ≥3) was achieved by inhaled methoxyflurane alone in 67 patients (61%). The analgesic effect was progressively better with increasing age. Side effects were frequent (n = 58, 53%) but mild. User satisfaction was scored as very good when pain relief was sufficient, but fair in patients without benefit. Technical problems were observed in 16 cases (14.7%), mainly related to filling of the inhaler. In every fifth use, the fruity smell of methoxyflurane was experienced as unpleasant. No negative effects on vital signs were observed. Conclusion In prehospital use, inhaled methoxyflurane as sole analgesic is effective for transport of trauma patients (62%) with moderate to severe pain. Older patients benefit especially from inhaled methoxyflurane. Side effects are mild and vital parameters unaffected. Thus, inhaled methoxyflurane could be a valuable device for non-physician EMS personnel rescue services also in the central Europe region.

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Section: Introductionmentioning

confidence: 99%

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Trimmel

Egger²,

Doppler³

et al. 2022

BMC Emerg Med

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“…The molecule can be used alone or combined with different active excipients. The main recommendations cite paracetamol as the first line for the treatment of moderate pain [ 16 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The analgesic pharmacological approach historically represents the cornerstone of pain management for acute traumatic injuries [ 3 , 16 ]. The pharmacological approach is only one component of an integrated, multidisciplinary approach aimed at reducing physical impairment, optimizing functional recovery, and improving the patient experience [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Traumatic Pain in the Emergency Department

et al. 2023

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Trauma is a major cause of mortality throughout the world. Traumatic pain—acute, sudden, or chronic—is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Patients’ perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60–70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients’ estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.

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“…Topical cryotherapy may also be used even though there is low evidence for its effectiveness. Non-pharmacologic methods of pain relief should not be prioritised in the case of life-threatening injuries [ 31 ]. At the same time, post-traumatic immobilisation should not be completely neglected even though—due to differences in the structure of the skeletal system of a child—such measures affect the further process of injury healing [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

Holak¹,

Czapla

Zielińska

2021

JCM

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Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

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Analgesie bei Traumapatienten in der Notfallmedizin

Cited by 16 publications

References 94 publications

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Acute Traumatic Pain in the Emergency Department

Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

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