Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting

Bounes, Vincent; Barniol, C.; Minville, Vincent; Houzé-Cerfon, Charles-Henri; Ducassé, J.-L.

doi:10.1016/j.ajem.2009.12.005

Cited by 37 publications

(31 citation statements)

References 24 publications

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“…Some of the firefighter teams include an emergency nurse, whose skills consist of drugs administration according to local protocols. This study took place in MidiPyr en ees district (1,156 under the scientific supervision of the Toulouse University Hospital SAMU (Purpan Hospital, Toulouse, France). French law makes no provision for anyone other than physicians to perform medical research, except for nurses under direct or indirect physician supervision.…”

Section: Study Setting and Populationmentioning

confidence: 99%

“…The use of intravenous (IV) analgesics (such as opioids) can be limited by concerns about the adverse effects of these drugs in this setting. 1 For a number of years, many rescue organizations throughout the world, including some employing caregivers not trained as emergency medical technicians, have made use of 50% nitrous oxide (N 2 O) and oxygen analgesia. 2 There has been limited clinical evidence for the efficacy of this form of analgesia.…”

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confidence: 99%

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Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

Ducassé

Siksik²,

Durand-Bechu

et al. 2013

Academic Emergency Medicine

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Objectives: Although 50% nitrous oxide (N 2 O) and oxygen is a widely used treatment, its efficacy had never been evaluated in the prehospital setting. The objective of this study was to demonstrate the efficacy of premixed N 2 O and oxygen in patients with out-of-hospital moderate traumatic acute pain.Methods: This prospective, randomized, multicenter, double-blind trial enrolled patients with acute moderate pain (numeric rating scale [NRS] score between 4 and 6 out of 10) caused by trauma. Patients were assigned to receive either 50/50 N 2 O and oxygen 9 L/min (N 2 O group) or medical air (MA) 9 L/min (MA group), in ambulances from two nurse-staffed fire department centers. After the first 15 minutes, every patient received N 2 O and oxygen. The primary endpoint was pain relief at 15 minutes (T15), defined as a NRS 3 of 10. The NRS was measured every 5 minutes. Secondary endpoints were treatment safety and adverse events, time to analgesia, and patient and investigator satisfaction with analgesia.Results: Sixty patients were included with no differences between groups in age (median = 34 years, interquartile range [IQR] = 23 to 53 years), sex (37 males, 66%), and initial median NRS of 6 (IQR = 5 to 6). At T15, 67% of the patients in the N 2 O group had an NRS score of 3 or lower versus 27% of those in the MA group (delta = 40%, 95% confidence interval [CI] = 17% to 63%; p < 0.001). The median pain scores were lower in the N 2 O group at T15, 2 (IQR = 1 to 4) versus 5 (IQR = 3 to 6). There was a difference at 5 minutes that persisted at all subsequent time points. Four patients (one in the N 2 O group) experienced adverse events (nausea) during the protocol. 1 For a number of years, many rescue organizations throughout the world, including some employing caregivers not trained as emergency medical technicians, have made use of 50% nitrous oxide (N 2 O) and oxygen analgesia.2 There has been limited clinical evidence for the efficacy of this form of analgesia. N 2 O has a low solubility in blood and is not bound to blood proteins. It acts rapidly and is quickly reversible after inhalation is discontinued. A search of the literature identified 12 randomized controlled trials investigating the use of 50% N 2 O (compared with placebo or conventional analgesic regimens) in a range of conditions.

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Section: Study Setting and Populationmentioning

confidence: 99%

mentioning

confidence: 99%

Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

Ducassé

Siksik²,

Durand-Bechu

et al. 2013

Academic Emergency Medicine

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“…Practitioners in our study took into account this complexity by acknowledging a number of issues over and above reported pain scores when deciding on analgesia, such as initial severity,13 34 time to hospital, chronicity or underlying causes, as in other studies 11. Pre-hospital assessment of pain is feasible10 and increases the likelihood of analgesia 35.…”

Section: Discussionmentioning

confidence: 99%

“…Both are safe41 42 but need to be used with caution, or are contraindicated in some conditions, and variation in individual response can lead to undertreatment 34. Patients' concerns about possible effects of analgesia on subsequent diagnosis is unfounded 43.…”

Section: Discussionmentioning

confidence: 99%

Patients' and emergency clinicians' perceptions of improving pre-hospital pain management: a qualitative study

2012

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“…[72][73][74][75][76][77][78][79][80] Wedmore and colleagues 74 reported on 286 U.S. military combat trauma patients treated with fentanyl lozenges and found that both pre-and post-analgesic pain assessment scores were reported for 68.9%. Civilian trauma care researchers report PH pain assessment rates from less than 20% 4 to 73.4%.…”

Section: Pain Assessment Documentationmentioning

confidence: 96%

Prevalence and Predictors of Prehospital Pain Assessment and Analgesic Use in Military Trauma Patients, 2010–2013

Blackman¹,

Cooper²,

Puntillo³

et al. 2016

Prehospital Emergency Care

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Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting

Cited by 37 publications

References 24 publications

Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

Patients' and emergency clinicians' perceptions of improving pre-hospital pain management: a qualitative study

Prevalence and Predictors of Prehospital Pain Assessment and Analgesic Use in Military Trauma Patients, 2010–2013

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