Paediatric prehospital analgesia in Auckland

Abstract

In children, younger age is a significant risk factor for receiving inadequate prehospital analgesia. Ambulance officers' concern about the pain of injection is the major identified factor for the relative underuse of morphine observed in younger children.

Prehospital pain management of injured children: a systematic review of current evidence

“…None of the children younger than 5 years received analgesia [22]. Another study with a similar patient population found a significant age bias disfavoring children younger than 5 years [23]. An Australian study comparing intravenous morphine, intranasal fentanyl, or inhaled methoxyflurane found children were less likely to receive opiate analgesia than adults [24].…”

An Evidence-based Guideline for Prehospital Analgesia in Trauma

“…Concerns regarding the initiation of IV access might be a particular concern in the pediatric population. 48 This is not an issue with fentanyl, as it can be safely and readily administered by the IN route. EMS systems will need to purchase atomizers for IN administration that may incur additional costs.…”

Safety of opioid patch initiation in Australian residential aged care

“…Provision of N 2 O in ambulances is hampered by difficulties providing a scavenger system that minimises occupational exposure and the bulk/logistical issues associated with managing cylinders of oxygen and nitrous oxide (Entonox® cylinders are a mixture of 50% N 2 O and 50% oxygen) that separate at low temperatures. The demand valves are costly and require maintenance, and the inability to activate the valve and effectively use Entonox® equipment has been rated as a major factor limiting use in children under 5 year (Watkins, 2006). There have been no RCTs of methoxyflurane Faddy & Garlick, 2005), and no large case series comparing efficacy with other analgesic agents in the prehospital setting.…”

“…Although N 2 O has been reported to provide pain relief in over 80% of patients requiring prehospital analgesia (Thomas & Shewakramani, 2008 Level IV), this is not based on RCTs (Faddy & Garlick, 2005) and there are few studies comparing efficacy with other agents. In one paediatric series, a higher proportion of children receiving N 2 O rather than opioids had pain on arrival in the emergency department, but interruption of delivery during transfer from the ambulance may have contributed (Watkins, 2006 Level IV). Based on data from hospital studies, N 2 O has been suggested as a safe analgesic in prehospital settings, although specific contra-indications (such as pneumothorax and decreased consciousness) may be particularly relevant in this patient group (Faddy & Garlick, 2005) (see Section 4.3.1 for further details).…”

“…One study of children with fractures or soft tissue injuries reported that 37% received prehospital analgesic drugs (Rogovik & Goldman, 2007 Level IV). Another, which included patients with a diagnosis of limb fracture or burns, reported that analgesia was given to 51% of children between the ages of 5 and 15 years, but not to any child aged less that 5 years; a greater proportion of this younger group (70% vs 54%) were given opioid analgesia once in the emergency department (Watkins, 2006 Level IV).…”