Ambulance Research Institute, Ambulance Service of NSW, Rozelle, New South Wales, Australia.
Prehosp Emerg Care. 2011 Apr-Jun;15(2):158-65. doi: 10.3109/10903127.2010.541980. Epub 2011 Feb 4.
To compare the effectiveness of intravenous morphine, intranasal (IN) fentanyl, and inhaled methoxyflurane for managing moderate to severe pain in pediatric patients in the out-of-hospital setting.
We conducted a retrospective comparative study of 3,312 pediatric patients aged between 5 and 15 years who had moderate to severe pain (pain score ≥ 5) and who received intravenous morphine, IN fentanyl, or inhaled methoxyflurane, either alone or in combination, between January 1, 2004, and November 30, 2006. Multivariate logistic regression was used to analyze data extracted from a clinical database containing routinely entered information from patient health care records. The primary outcome measure was effective analgesia, defined as a reduction in pain severity of ≥ 30% of initial pain score using an 11-point verbal numeric rating scale.
Effective analgesia was achieved in 82.5% of cases overall. All analgesic agents were effective in the majority of patients (87.5%, 89.5%, and 78.3% for morphine, fentanyl, and methoxyflurane, respectively). There was evidence that methoxyflurane was less effective than both morphine (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.36-0.74) and fentanyl (OR 0.43; 95% CI 0.29-0.62; p < 0.0001). There was no clinical or statistical evidence of difference in the effectiveness of fentanyl and morphine in this population (OR 1.22; 95% CI 0.74-2.01). There was no evidence that combination analgesia was better than either fentanyl or morphine alone.
Intranasal fentanyl and intravenous morphine are equally effective analgesic agents in pediatric patients with moderate to severe acute pain in the out-of-hospital setting. Methoxyflurane is less effective in comparison with both morphine and fentanyl, but is an effective analgesic in the majority of children.
比较静脉注射吗啡、鼻内（IN）芬太尼和吸入甲氧氟烷在院外环境中治疗儿童中度至重度疼痛的效果。
我们对 2004 年 1 月 1 日至 2006 年 11 月 30 日期间因中度至重度疼痛（疼痛评分≥5）而接受静脉注射吗啡、IN 芬太尼或吸入甲氧氟烷（单独或联合使用）的 3312 名 5 至 15 岁儿科患者进行了回顾性比较研究。使用多元逻辑回归分析从临床数据库中提取的数据，该数据库包含从患者健康记录中常规输入的信息。主要观察指标为有效镇痛，定义为使用 11 点数字评分量表评估初始疼痛评分降低≥30%。
总体而言，有效镇痛的比例为 82.5%。所有镇痛剂在大多数患者中均有效（吗啡、芬太尼和甲氧氟烷的有效率分别为 87.5%、89.5%和 78.3%）。有证据表明，甲氧氟烷的效果不如吗啡（比值比 [OR] 0.52；95%置信区间 [CI] 0.36-0.74）和芬太尼（OR 0.43；95% CI 0.29-0.62；p<0.0001）。在该人群中，芬太尼和吗啡的有效性无临床或统计学差异（OR 1.22；95% CI 0.74-2.01）。没有证据表明联合镇痛比单独使用芬太尼或吗啡更好。
在院外环境中治疗儿童中度至重度急性疼痛时，鼻内芬太尼和静脉注射吗啡均为有效的镇痛剂。与吗啡和芬太尼相比，甲氧氟烷的效果较差，但在大多数儿童中仍为有效的镇痛剂。
