院前环境中鼻内给予芬太尼与静脉注射吗啡用于镇痛的随机对照试验。

A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting.

作者信息

Rickard Claire, O'Meara Peter, McGrail Matthew, Garner David, McLean Alan, Le Lievre Peter

机构信息

Research Centre for Practice Innovation, Griffith University, Nathan, Queensland 4111, Australia.

出版信息

Am J Emerg Med. 2007 Oct;25(8):911-7. doi: 10.1016/j.ajem.2007.02.027.

DOI:10.1016/j.ajem.2007.02.027

PMID:17920976

Abstract

STUDY OBJECTIVE

The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia.

METHODS

This was a randomized, controlled, open-label trial. Consecutive adult patients (n = 258) requiring analgesia (Verbal Rating Score [VRS] >2/10 noncardiac or >5/10 cardiac) were recruited. Patients received INF 180 mug +/- 2 doses of 60 mug at > or =5-minute intervals or IVM 2.5 to 5 mg +/- 2 doses of 2.5 to 5 mg at > or =5-minute intervals. The end point was the difference in baseline/destination VRS.

RESULTS

Groups were equivalent (P = not significant) for baseline VRS [mean (SD): INF 8.3 (1.7), IVM 8.1 (1.6)] and minutes to destination [mean (SD): INF 27.2 (15.5), IVM 30.6 (19.1)]. Patients had a mean (95% confidence interval) VRS reduction as follows: INF 4.22 (3.74-4.71), IVM 3.57 (3.10-4.03); P = .08. Higher baseline VRS (P < .001), no methoxyflurane use (P < .01), and back pain (P = .02) predicted VRS reduction. Safety and acceptability were comparable.

CONCLUSIONS

There was no significant difference in the effectiveness of INF and IVM for prehospital analgesia.

摘要

研究目的

本研究的目的是比较鼻内给予芬太尼（INF）和静脉注射吗啡（IVM）用于院前镇痛的效果。

方法

这是一项随机、对照、开放标签试验。招募了连续的成年患者（n = 258），这些患者需要镇痛（非心脏原因的语言评分量表[VRS]>2/10或心脏原因的VRS>5/10）。患者接受180微克INF，必要时每隔≥5分钟追加2剂60微克，或接受2.5至5毫克IVM，必要时每隔≥5分钟追加2剂2.5至5毫克。终点是基线/目的地VRS的差异。

结果

两组在基线VRS方面相当（P = 无显著差异）[平均值（标准差）：INF 8.3（1.7），IVM 8.1（1.6）]，到达目的地的时间也相当[平均值（标准差）：INF 27.2（15.5），IVM 30.6（19.1）]。患者的VRS平均降低值如下：INF 4.22（3.74 - 4.71），IVM 3.57（3.10 - 4.03）；P = 0.08。较高的基线VRS（P < 0.001）、未使用甲氧氟烷（P < 0.01）和背痛（P = 0.02）预示着VRS降低。安全性和可接受性相当。