Effectiveness of Morphine, Fentanyl, and Methoxyflurane in the Prehospital Setting

Middleton, Paul; Simpson, Paul; Sinclair, Gary I.; Dobbins, Timothy; Math, B; Bendall, Jason C

doi:10.3109/10903127.2010.497896

Cited by 78 publications

(79 citation statements)

References 30 publications

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“…The mean dose of fentanyl used in our study is in line with the proposed doses in the literature [8,9,[12][13][14][15] including in the specific setting of mountain rescue [2]. The mean dose of intra-nasal fentanyl was lower than when used intravenously, which is partially explained by a significantly higher proportion of paediatric patients in the intranasal group.…”

Section: Analgesic Strategiessupporting

confidence: 73%

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

Pasquier¹,

Eidenbenz²,

Dami³

et al. 2017

Emerg Med

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Objective: The delivery of a safe an effective analgesia is a core principle and a priority of prehospital care. Analgesia in hostile environments (mountain settings, etc.) presents various challenges, and the benefit-risk ratio of the procedure should be evaluated. The objective of this study was to examine pain management strategies and the time spent on scene for analgesia provisions in an alpine environment. Methods:We undertook a retrospective study from a single physician-staffed helicopter emergency medical service in the Swiss Alps. Patients with isolated limb injuries were included. We examined the choice and route of analgesic medication, patient monitoring, medical co-treatments and time delays during the rescue mission.Results: Analgesia was provided to 657 (57%) of the 1156 included patients. Fentanyl was most commonly administered followed by ketamine, with or without fentanyl. Heart rhythm monitoring, oxygen administration, and saline infusion were used infrequently, but were used significantly more often in patients treated with ketamine. The median time on site was 6 minutes longer for patients receiving intravenous analgesia compared with those not receiving it.Conclusion: Analgesia in hostile environments seems to be limited to essential procedures. The safety of this approach must be confirmed.

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Section: Analgesic Strategiessupporting

confidence: 73%

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

Pasquier¹,

Eidenbenz²,

Dami³

et al. 2017

Emerg Med

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“…19,40,41 A number of observational studies in prehospital and emergency department settings have evaluated the efficacy and safety of fentanyl and morphine. [29][30][31][32]42,43,44 These studies uniformly showed that fentanyl and morphine compare favorably to one another in both the reduction of pain and lack of adverse events. In 2006, Kanowitz et al conducted a retrospective chart review of 2,129 patients who were administered fentanyl in an out-of-hospital setting and concluded fentanyl was effective in decreasing pain scores without causing substantial hypotension, respiratory depression, hypoxia, or sedation.…”

Section: Safety and Efficacymentioning

confidence: 99%

“…28,[31][32][33]35 There were few direct comparisons made between IV morphine and IV fentanyl, although a number of studies compared IN fentanyl with IM or IV morphine. [29][30][31][32]36 Intravenous administration was the most commonly researched route for fentanyl, but in a few observational studies, intranasal delivery appeared to be safe, effective, and less painful than intravenous cannulation. 36 While the panel acknowledges the potential value of administering analgesia via intraosseous access, there was little evidence in the prehospital literature to inform a recommendation.…”

Section: Routesmentioning

confidence: 99%

“…Morphine and fentanyl appeared to be well tolerated and resulted in quantifiable decreases in both self-reported and objectively measured pain scores. [29][30][31][32][33] Fentanyl is a versatile agent in that it can be administered via transmucosal, intranasal, and intravenous routes. It is rapid in onset (within t max 5-16 min) and has duration of action up to 65 min.…”

Section: Safety and Efficacymentioning

confidence: 99%

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An Evidence-based Guideline for Prehospital Analgesia in Trauma

Gausche‐Hill¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

120

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Background. The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. Objective. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Results. Four strong

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“…Differing formulations for IN fentanyl have been developed [199], but the overall efficacy results are similar: IN fentanyl data are incomplete but the approach has promise for a variety of patient types [200][201][202]. It appears possible that, while the analgesic efficacy may not match that of IV morphine, the ease of administration may render IN fentanyl (one commonly used dose is 1.5 mcg/kg via atomizer) a viable option in some situations [203]. While there are some preliminary data on IN fentanyl use, the state of the art for this approach is that it is prime subject matter for clinical research rather than widespread adoption [204].…”

Section: Fentanylmentioning

confidence: 99%

Management of Pain in the Emergency Department

Thomas

2013

ISRN Emergency Medicine

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Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.

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Effectiveness of Morphine, Fentanyl, and Methoxyflurane in the Prehospital Setting

Cited by 78 publications

References 30 publications

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Management of Pain in the Emergency Department

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