Nasal Nalbuphine Analgesia in Prehospital Trauma Management by First-Responder Personnel on Ski Slopes in Switzerland

Abstract

Background Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in trauma. Due to the mountainous topography, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders (FR) may improve overall treatment. We therefore assessed the use of nasally administered Nalbuphine as analgesic treatment in trauma patients by FR at various skis resort in Switzerland.Methods This observational study examined a cohort of 267 patients given Nalbuphine by FR in various ski resorts in Switzerland. All FR were instructed how to administer Nalbuphine before treating patients. A treatment algorithm was developed and distributed to assure that Nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of Nalbuphine were collected on-site. Refills were handed out with each completed questionnaire.Results Nalbuphine decreased the level of pain statistically significant and clinically relevant by a median of 3 units on the NRS for pain. The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain level. Nalbuphine was less effective in patients aged 20-60 years compared to the adolescent population. No major side effects were observed.Conclusion Nasal Nalbuphine by FR was a noninvasive pain management strategy that provided safe and effective analgesia in prehospital, acute­ly injured patients. This may be an alternative method especially in circumstances of severe pain and prolonged time between arrival of the FR and arrival of EMS / HEMS personnel on scene.