Oligoanalgesia in the emergency setting – An Indian review

Vijayvargiya, Mayank; Panchal, Snehal; Asawale, Ketan; Desai, Akshay S.

doi:10.1016/j.jcot.2021.03.025

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…This led to a decrease in patient satisfaction, heightened mental distress and prolonged duration of stay in the ED. [1][2][3] The British Association of Accident and Emergency Medicine…”

Section: Introduction Problem Descriptionmentioning

confidence: 99%

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Sadasivam S,

Kumaran,

Manu Ayyan

et al. 2024

BMJ Open Qual

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IntroductionPain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement. This initiative aimed to expedite the administration of the first analgesic in patients with musculoskeletal pain in the ED.Local problemObservations within our ED revealed that patients with musculoskeletal injuries triaged to yellow or green areas experienced prolonged waiting times, leading to delayed analgesic administration, thereby adversely affecting clinical care and patient satisfaction.Specific aimThe aim of our quality improvement (QI) project was to reduce the time to administration of first analgesia by 30% from baseline, in patients with musculoskeletal injuries presenting to our academic ED, in a period of 8 weeks after the baseline phase.MethodsA multidisciplinary QI team systematically applied Point-of-Care Quality Improvement and Plan-Do-Study-Act (PDSA) cycle methodologies. Process mapping and fishbone analyses identified the challenges in analgesia administration. Targeted interventions were iteratively refined through PDSA cycles.InterventionsInterventions such as pain score documentation at triage, fast-tracking of patients with moderate-to-severe pain, resident awareness sessions, a pain management protocol and prescription audits were executed during the PDSA cycles. Successful elements were reinforced and adjustments were made to address the identified challenges.ResultsThe median door-to-analgesia timing during the baseline phase was 55.5 min (IQR, 25.75–108 min). During the postintervention phase, the median was significantly reduced to 15 min (IQR, 5–37 min), exceeding the anticipated outcomes and indicating a substantial 73% reduction (p value <0.001) from baseline.ConclusionImplementing simple change ideas resulted in a substantial improvement in door-to-analgesia timing within the ED. These findings significantly contribute to ongoing discussions on the optimisation of pain management in emergency care.

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“…This led to a decrease in patient satisfaction, heightened mental distress and prolonged duration of stay in the ED. [1][2][3] The British Association of Accident and Emergency Medicine…”

Section: Introduction Problem Descriptionmentioning

confidence: 99%

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Sadasivam S,

Kumaran,

Manu Ayyan

et al. 2024

BMJ Open Qual

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Prähospitale Analgesie mit Nalbuphin und Paracetamol im Vergleich zu Piritramid durch Notfallsanitäter*innen – eine multizentrische Observationsstudie

Deslandes,

Deicke,

Grannemann

et al. 2024

Anaesthesiologie

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Zusammenfassung Fragestellung Angesichts der Änderungen des Betäubungsmittelgesetzes untersucht die vorliegende Arbeit die prähospitale Analgesie durch Notfallsanitäter*innen mittels Piritramid vs. Nalbuphin + Paracetamol. Material und Methode Alle prähospitalen Analgesien durch Notfallsanitäter*innen der Rettungsdienste der Kreise Fulda (Piritramid) sowie Gütersloh (Nalbuphin + Paracetamol) wurden im Hinblick auf die Schmerzstärke anhand der Numeric Rating Scale (NRS) zu Einsatzbeginn und -ende sowie die aufgetretenen Komplikationen ausgewertet. Ergebnisse Insgesamt wurden 2429 Analgesien ausgewertet (Nalbuphin + Paracetamol: 1635 (67,3 %), NRS-initial: 8,0 ± 1,4, NRS-Einsatzende: 3,7 ± 2,0; Piritramid: 794 (32,7 %), NRS-initial: 8,5 ± 1,1, NRS-Einsatzende: 4,5 ± 1,6). Faktoren mit Einfluss auf eine NRS-Veränderung waren: initiale NRS (Regressionskoeffizient (RK): 0,7075, 95 %-Konfidenzintervall (95 %-KI): 0,6503–0,7647, p < 0,001) sowie Therapie mit Nalbuphin + Paracetamol (RK: 0,6048, 95 %-KI: 0,4396–0,7700, p < 0,001). Die Therapie mit Nalbuphin + Paracetamol (n = 796 (48,7 %)) im Vergleich zu Piritramid (n = 190 (23,9 %)) erhöhte die Chancen, eine NRS < 4 am Einsatzende aufzuweisen (Odds Ratio (OR): 2,712, 95 %-KI: 2,227–3,303, p < 0,001). Komplikationen traten bei Therapie mit Piritramid bei n = 44 (5,5 %) und bei Nalbuphin + Paracetamol bei n = 35 (2,1 %) auf. Risikofaktoren für Komplikationen waren Analgesie mit Piritramid (OR: 2,699, 95 %-KI: 1,693–4,301, p < 0,001), weibliches Geschlecht (OR: 2,372, 95 %-KI: 1,396–4,029, p = 0,0014) sowie das Lebensalter (OR: 1,013, 95 %-KI: 1,002–1,025, p = 0,0232). Diskussion Im Vergleich mit Piritramid weist die prähospitale Analgesie mit Nalbuphin + Paracetamol günstige Effekte im Hinblick auf analgetische Effektivität und Komplikationsraten auf und sollte in zukünftigen Empfehlungen für Notfallsanitäter*innen berücksichtigt werden.

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Effectiveness and safety of prehospital analgesia with nalbuphine and paracetamol versus morphine by paramedics - an observational study

Deslandes,

Deicke,

Grannemann

et al. 2024

Scand J Trauma Resusc Emerg Med

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Background Despite the development of various analgesic concepts, prehospital oligoanalgesia remains very common. The present work examines prehospital analgesia by paramedics using morphine vs. nalbuphine + paracetamol. Methods Patients with out-of-hospital-analgesia performed by paramedics from the emergency medical services of the districts of Fulda (morphine) and Gütersloh (nalbuphine + paracetamol) were evaluated with regards to pain intensity at the beginning and the end of prehospital treatment using the Numeric-Rating-Scale for pain (NRS), sex, age, and complications. The primary endpoint was achievement of adequate analgesia, defined as NRS < 4 at hospital handover, depending on the analgesics administered (nalbuphine + paracetamol vs. morphine). Pain intensity before and after receiving analgesia using the NRS, sex, age and complications were also monitored. Results A total of 1,808 patients who received out-of-hospital-analgesia were evaluated (nalbuphine + paracetamol: 1,635 (90.4%), NRS-initial: 8.0 ± 1.4, NRS-at-handover: 3.7 ± 2.0; morphine: 173(9.6%), NRS-initial: 8.5 ± 1.1, NRS-at-handover: 5.1 ± 2.0). Factors influencing the difference in NRS were: initial pain intensity on the NRS (regression coefficient (RK): 0.7276, 95%CI: 0.6602–0.7950, p < 0.001), therapy with morphine vs. nalbuphine + paracetamol (RK: -1.2594, 95%CI: -1.5770 - -0.9418, p < 0.001) and traumatic vs. non-traumatic causes of pain (RK: -0.2952, 95%CI: -0.4879 - -0.1024, p = 0.002). Therapy with morphine (n = 34 (19.6%)) compared to nalbuphine + paracetamol (n = 796 (48.7%)) (odds ratio (OR): 0.274, 95%CI: 0.185–0.405, p < 0.001) and the initial NRS score (OR:0.827, 95%CI: 0.771–0.887, p < 0.001) reduced the odds of having an NRS < 4 at hospital handover. Complications occurred with morphine in n = 10 (5.8%) and with nalbuphine + paracetamol in n = 35 (2.1%) cases. Risk factors for complications were analgesia with morphine (OR: 2.690, 95%CI: 1.287–5.621, p = 0.008), female sex (OR: 2.024, 95%CI: 1.040–3.937, p = 0.0379), as well as age (OR: 1.018, 95%CI: 1.003–1.034, p = 0.02). Conclusions Compared to morphine, prehospital analgesia with nalbuphine + paracetamol yields favourable effects in terms of analgesic effectiveness and a lower rate of complications and should therefore be considered in future recommendations for prehospital analgesia.

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Oligoanalgesia in the emergency setting – An Indian review

Cited by 4 publications

References 23 publications

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

Prähospitale Analgesie mit Nalbuphin und Paracetamol im Vergleich zu Piritramid durch Notfallsanitäter*innen – eine multizentrische Observationsstudie

Effectiveness and safety of prehospital analgesia with nalbuphine and paracetamol versus morphine by paramedics - an observational study

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