Prise en charge de la douleur chez l’adulte dans des services d’urgences en France en 2010

Boccard, E.; Adnet, Frédéric; Gueugniaud, P. Y.; Filipovics, A.; Ricard-Hibon, A.

doi:10.1007/s13341-011-0094-4

Cited by 25 publications

(13 citation statements)

References 18 publications

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“…Un quart des patients n'a pas reçu d'antalgique et les paliers II et III étaient insuffisamment prescrits au regard de l'intensité douloureuse à l'admission. Cette sous-utilisation des antalgiques avait déjà été décrite en 2001 par Clère et al sur un faible échantillon de douleurs abdominales [29] et par l'étude française PALIERS en 2011 [3]. Il est intéressant de constater que, dans cette dernière étude, 47 % des patients présentaient une douleur à la sortie des urgences, dont 30 % une douleur modérée à sévère.…”

Section: Discussionunclassified

“…Bien qu'étant un motif fréquent de consultation, la douleur y reste insuffisamment prise en charge [3,4]. Historiquement, les analgésiques ont été sous-utilisés dans le traitement des douleurs abdominales aiguës [5], de crainte de masquer des signes cliniques, de gêner le diagnostic, ou d'induire des effets secondaires (dépendance aux opiacés).…”

Section: Introductionunclassified

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Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

Durand

Bounes

Lauque

2015

Ann. Fr. Med. Urgence

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Objectif : L'objectif de notre étude était de détermi-ner l'incidence de la chronicisation des douleurs chez les patients ayant consulté aux urgences pour une douleur abdominale aiguë non traumatique. Patients et méthode : Nous avons réalisé une étude rétrospec-tive au sein des urgences d'un hôpital universitaire entre juin 2013 et juin 2014. Les patients ont été sélectionnés via la banque informatisée des données des urgences, puis contactés pour un entretien téléphonique trois mois après leur passage aux urgences. Le critère de jugement principal était la persistance d'un score douloureux par échelle numérique (EN) supérieur à 3, à une fréquence minimale de deux fois par mois, trois mois après le passage aux urgences. Résultats : Sur les 440 patients éligibles, 200 patients ont pu être contactés et ont donné leur consentement. Quarante-deux patients (21 %) décrivaient la persistance d'une douleur avec une EN supérieure à 3/10 au moins deux fois par mois. Les facteurs associés à un risque de chronicisation étaient : l'âge (ratio de côtes (RC) 1,02 IC95 % [1,01-1,05] par année) et le score de la classification clinique des malades aux urgences (RC 0,40 IC95 % [0,21-0,75] par unité). Cent vingt-deux patients (61 %) n'ont pas présenté de récidive douloureuse dans les trois mois suivant leur admission aux urgences. Conclusion : La chronicisation des douleurs après une consultation aux urgences pour des douleurs abdominales aiguës concerne un patient sur cinq. L'âge et la gravité initiale de l'état clinique sont des facteurs prédictifs de chronicisation. L'absence de diagnostic organique (41 %) n'était pas associée, dans notre étude, à un risque de chronicisation. Mots clés Douleur abdominale · Chronicisation · OligoanalgésieAbstract Objective: The aim of this study was to investigate incidence of chronicization of pain in patients suffering from acute non-traumatic abdominal pain and discharged from emergency department (ED). Methods: We conducted a retrospective study in an academic hospital ED between June 2013 and June 2014. Patients were selected on ED electronic database, and then contacted for a phone interview three months after discharge. The main outcome was a pain score up to 3/10 on a numerous scale, more than twice a month, three months after discharge from ED. Results: Among the 440 patients completing inclusion criteria, 200 patients were contacted and gave their consent. Forty-two patients (21%) reported abdominal pain with an intensity more than 3/10 and with a frequency more than twice a month. Factors associated with pain chronicization where age (odds-ratio (OR) 1,02 IC95% [1,01-1,05] pear year and clinical gravity score at admission (OR 0,40 IC95% [0,21-0,75] pear level). One hundred and twenty two patients (61%) reported no pain during the three months of follow-up. Conclusions: One patient out of five is exposed to chronicization of his abdominal pain three months after discharge from ED. Age and clinical gravity score at admission are risk factors for pain chronicization. The lack of organic d...

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Section: Discussionunclassified

Section: Introductionunclassified

Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

Durand

Bounes

Lauque

2015

Ann. Fr. Med. Urgence

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“…Despite legal provisions and learned society recommendations, IVMT remains insufficiently applied or applied with delays [17]. The availability of morphine is good (low direct costs, low indirect costs of nursing administration and educational intervention), but the real requirements of opioids are still too limited, and oligoanalgesia persists in many countries [18–20].…”

Section: Introductionmentioning

confidence: 99%

Nebulized versus intravenous morphine titration for the initial treatment of severe acute pain in the emergency department: study protocol for a multicenter, prospective randomized and controlled trial, CLIN-AEROMORPH

Lvovschi

Joly

Lemaire

et al. 2019

Trials

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Background Intravenous morphine titration (IVMT) is the French gold standard for opioid treatment in the emergency department (ED). Nebulized morphine titration (NMT) may represent an alternative without venous access, but it has not been adequately studied in adults. We test the hypothesis that NMT is at least as effective as IVMT to initially manage severe acute pain in the ED. Methods/design We designed a multicenter (10 French EDs), single-blind, randomized and controlled trial. Adults between 18 and 75 years with visual analog scale (VAS) ≥ 70/100 or numeric rating scale (NRS) ≥ 7/10 will be enrolled. We will randomize 850 patients into two groups to compare two routes of MT as long as VAS > 30 or NRS > 3. In group A (425), patients will receive an initial NMT for 5–25 min associated with titration of an intravenously (IV) administered placebo of physiologic serum (PS). In group B (425), patients will receive IVMT plus nebulized PS placebo. NMT is defined as a minimum of 1 and a maximum of 3 5-min nebulized boluses of 10 mg or 15 mg (weight ≥ 60 kg), at 10-min fixed intervals. IVMT is defined as a minimum of 1 and a maximum of 6 boluses of 2 mg or 3 mg (weight ≥ 60 kg), at 5-min fixed intervals. Nebulized placebo titration will be performed every 10 min. IV titration of PS will be performed every 5 min. In both groups, after 25 min, if VAS > 30/100 or NRS > 3/10, routine IVMT will be continued until pain relief. Pain severity, vital signs, bronchospasm, and Ramsay score will be recorded every 5 min. The primary outcome is the rate of relief obtained 1 h from the start of drug administration. Complete pain relief in both groups will be compared with a non-inferiority design. Secondary outcomes are pain relief at 30 min (the end of NMT) and at 2 h and median pain relief. We will compare final doses, and study the feasibility and tolerance of NMT (protocol deviations, respiratory or hemodynamic depression, sedation, and minor vegetative side effects). Co-analgesia will be recorded. Discharge criteria from the ED and hospital are defined. Discussion This trial is the first multicenter randomized and controlled NMT protocol for severe pain in the ED using the titration concept. We propose an original approach of combined titration with an endpoint at 1 h and a non-inferiority design. Trial registration ClinicalTrials.gov, NCT03257319 . Registered on 22 August 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3326-3) contains supplementary material, which is available to authorized users.

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“…Current guidelines recommend analgesia for moderate and severe pain to be initiated within 20 minutes of arrival in the ED [ 3 ], but this is not always feasible. In the French multicenter PALIERS study, the time between arrival at the ED and initiation of treatment with an analgesic drug was 60 minutes for 38% (379/988) of patients with acute pain [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

Casamayor¹,

DiDonato²,

Hennebert³

et al. 2018

DIC

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BackgroundAcute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderate-to-severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach.ScopeA structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting. The data identified in this literature review constituted the source for all model input parameters, which were clustered as analgesic (morphine), material used for IV morphine administration, nurse workforce time and management of morphine-related adverse events and IV-related complications.FindingsThe cost per patient of IV morphine administration in the ED ranges between €18.31 in Spain and €28.38 in Germany. If costs associated with the management of morphine-related adverse events and IV-related complications are also considered, the total costs amount to €121.13–€132.43. The main driver of those total costs is the management of IV-related complications (phlebitis, extravasation and IV prescription errors; 73% of all costs) followed by workforce time (14%).ConclusionsIV morphine provides effective pain relief in the ED, but the costs associated with the IV administration inflict an economic burden on the respective national health services in EU5. An equally rapid-onset and efficacious analgesic that does not require IV administration could reduce this burden.

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Prise en charge de la douleur chez l’adulte dans des services d’urgences en France en 2010

Cited by 25 publications

References 18 publications

Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

Chronicization of non-traumatic acute abdominal pain in emergency department: Incidence and predictive factors

Nebulized versus intravenous morphine titration for the initial treatment of severe acute pain in the emergency department: study protocol for a multicenter, prospective randomized and controlled trial, CLIN-AEROMORPH

Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

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