Smith Michael D, Wang Yang, Cudnik Michael, Smith Dawn A, Pakiela John, Emerman Charles L
Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
J Emerg Med. 2012 Jul;43(1):69-75. doi: 10.1016/j.jemermed.2011.05.018.
Morphine and fentanyl are both frequently used in prehospital trauma patients, but due to limited formulary size, we sought to study whether both drugs should be included.
The purpose of this study was to evaluate the effectiveness and safety of fentanyl as compared to morphine for patients requiring analgesic medications for a traumatic injury during transport via a physician-staffed air medical service.
Trauma patients were grouped by even and odd days (even - morphine 4 mg, odd - fentanyl 50 μg). Patients were excluded based on age (< 18 or > 64 years), hypotension, inability to communicate a pain score (intubated), or known allergy to the study drugs. During the flight, medical crew assessed numeric pain score, vital signs, and incidence of pruritis or nausea.
There were 103 patients enrolled in the morphine arm and 97 patients in the fentanyl arm. The mean pain score at the beginning of enrollment was 8.0 ± 2.0 in the morphine arm and 8.0 ± 1.8 in the fentanyl arm. The mean final pain score was 5.8 ± 2.7 in the morphine arm and 5.5 ± 2.4 in the fentanyl arm (n.s. by either t-test or non-parametric testing). There was no significant difference in analgesia between fentanyl and morphine. There were no significant differences in the incidence of pruritis or vomiting between the two groups. Average transport time was 37 ± 8 min in the morphine group, and 43 ± 11 min in the fentanyl group. Average number of morphine doses was 3 ± 1.2. For fentanyl, average number of doses was 3 ± 1.3.
In our study, there was not a significant difference in analgesic effectiveness between morphine and fentanyl. There was no significant difference in the incidence of adverse effects between the two drugs. Our study suggests that either drug can be used safely with equivalent effectiveness.
吗啡和芬太尼都常用于院前创伤患者，但由于药品目录规模有限，我们试图研究这两种药物是否都应被纳入。
本研究的目的是评估在由配备医生的空中医疗服务转运期间，对于因创伤性损伤需要镇痛药物的患者，芬太尼与吗啡相比的有效性和安全性。
创伤患者按偶数日和奇数日分组（偶数日——吗啡4毫克，奇数日——芬太尼50微克）。基于年龄（<18岁或>64岁）、低血压、无法传达疼痛评分（插管患者）或已知对研究药物过敏而将患者排除。在飞行过程中，医护人员评估数字疼痛评分、生命体征以及瘙痒或恶心的发生率。
吗啡组有103名患者，芬太尼组有97名患者。入组开始时，吗啡组的平均疼痛评分为8.0±2.0，芬太尼组为8.0±1.8。吗啡组的最终平均疼痛评分为5.8±2.7，芬太尼组为5.5±2.4（通过t检验或非参数检验均无统计学差异）。芬太尼和吗啡之间的镇痛效果无显著差异。两组之间瘙痒或呕吐的发生率无显著差异。吗啡组的平均转运时间为37±8分钟，芬太尼组为43±11分钟。吗啡的平均剂量数为3±1.2。对于芬太尼而言，平均剂量数为3±1.3。
在我们的研究中，吗啡和芬太尼之间的镇痛效果无显著差异。两种药物的不良反应发生率无显著差异。我们的研究表明，两种药物均可安全使用且效果相当。
