Efficacy and Safety of Methoxyflurane for Treatment of Acute Traumatic Pain by EMTs during Alpine Rescue Operations: The “PainDrop” Trial

Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study

“…The verbal rating scale (VRS) or numerical rating scale (NRS) are such validated quick and easy pain scores for measuring pain and are commonly used to quantify subjective pain perception. The observed reduction in pain of 3 (IQR 2 to 4) NRS points was equal or even superior to other analgesia strategies in remote terrain—such as methoxyflurane with a 2.9-point NRS reduction—and is consistent with the findings for OTFC in a military setting [ 5 , 10 – 12 ]. In the literature, pain reduction of more than 25% is generally seen as sufficient treatment of pain; with a value of about 40% in each of our subgroups, we consider the effect successful.…”

“…Although there are different ways of successfully distributing strong analgesia without establishing an i.v. line, such as nasal administration of fentanyl, ketamine or nalbuphine [ 3 , 10 , 12 ], a potential downside of nasal administration can be slower onset, especially in cold environments, and a weaker effect due to vasoconstriction of the nasal vessels or congestion of the nasal cavity with mucus. Enteral application tends to be too slow in onset and does not play a significant role in the time-dependent prehospital setting.…”

“…Implementation in civilian practice of clinical innovations from recent military campaigns is essential to ensure that hard-won lessons are translated for use in a civilian application [ 8 , 9 ]. Unfortunately, there is limited data describing the use of OTFC for civil prehospital trauma patients so far [ 10 ]. Therefore, our goal was to apply this experience in a similar setting, namely mountain rescue in the Swiss alps, where extrication requires simple usage and fast acting pain relief that can be safely administered by first responders and EMS personnel without the need for an intravenous line.…”