口腔黏膜芬太尼枸橼酸盐用于战场院前疼痛控制的安全性和有效性。

Safety and efficacy of oral transmucosal fentanyl citrate for prehospital pain control on the battlefield.

机构信息

US Army Austere and Wilderness Medicine Fellowship, Madigan Army Medical Center, Fort Bragg, North Carolina, USA.

出版信息

J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S490-5. doi: 10.1097/TA.0b013e3182754674.

DOI:10.1097/TA.0b013e3182754674

PMID:23192075

Abstract

BACKGROUND

Acute pain, resulting from trauma and other causes, is a common condition that imposes a need for prehospital analgesia on and off the battlefield. The narcotic most frequently used for prehospital analgesia on the battlefield during the past century has been morphine. Intramuscular morphine has a delayed onset of pain relief that is suboptimal and difficult to titrate. Although intravenously administered morphine can readily provide rapid and effective prehospital analgesia, oral transmucosal fentanyl citrate (OTFC) is a safe alternative that does not require intravenous access. This study evaluates the safety and efficacy of OTFC in the prehospital battlefield environment.

METHODS

Data collected during combat deployments (Afghanistan and Iraq) from March 15, 2003, to March 31, 2010, were analyzed. Patients were US Army Special Operations Command casualties. Patients receiving OTFC for acute pain were evaluated. Pretreatment and posttreatment pain intensities were quantified by the verbal numeric rating scale (NRS) from 0 to 10. OTFC adverse effects and injuries treated were also evaluated.

RESULTS

A total of 286 patients were administered OTFC, of whom 197 had NRS pain evaluations conducted before and approximately 15 minutes to 30 minutes following treatment. The difference between NRS pain scores at 0 minutes (NRS, 8.0 [1.4]) and 15 minutes to 30 minutes (NRS, 3.2 [2.1]) was significant (p < 0.001). Only 18.3% (36 of 197) of patients were also administered other types of analgesics. Nausea was the most common adverse effect as reported by 12.7% (25 of 197) of patients. The only major adverse effect occurred in the patient who received the largest opioid dose, 3,200-µg OTFC and 20-mg morphine. This patient exhibited hypoventilation and saturation of less than 90% requiring low-dose naloxone.

CONCLUSION

OTFC is a rapid and noninvasive pain management strategy that provides safe and effective analgesia in the prehospital battlefield setting. OTFC has considerable implications for use in civilian prehospital and austere environments.

LEVEL OF EVIDENCE

Therapeutic study, level IV.

摘要

背景

创伤和其他原因引起的急性疼痛是一种常见病症，需要在战场内外进行院前镇痛。在过去一个世纪中，在战场上用于院前镇痛的最常用的麻醉剂是吗啡。肌肉注射吗啡的止痛效果延迟，且效果不理想，难以滴定。虽然静脉内给予吗啡可以迅速有效地提供院前镇痛，但口服粘膜芬太尼枸橼酸盐（OTFC）是一种安全的替代方法，不需要静脉通路。本研究评估了 OTFC 在院前战场环境中的安全性和有效性。

方法

分析了 2003 年 3 月 15 日至 2010 年 3 月 31 日期间在战斗部署期间（阿富汗和伊拉克）收集的数据。患者是美国陆军特种作战司令部的伤员。评估了接受 OTFC 治疗急性疼痛的患者。通过数字评分量表（NRS）从 0 到 10 量化治疗前和治疗后 15 分钟至 30 分钟的疼痛强度。还评估了 OTFC 的不良反应和治疗的损伤。

结果

共有 286 名患者接受了 OTFC 治疗，其中 197 名患者进行了 NRS 疼痛评估，在治疗前和治疗后 15 分钟至 30 分钟进行了评估。0 分钟（NRS，8.0 [1.4]）和 15 分钟至 30 分钟（NRS，3.2 [2.1]）之间的 NRS 疼痛评分差异具有统计学意义（p < 0.001）。只有 18.3%（197 名患者中的 36 名）的患者还接受了其他类型的镇痛药。报告有 12.7%（197 名患者中的 25 名）的患者出现恶心等最常见的不良反应。唯一的主要不良反应发生在接受最大阿片类药物剂量的患者身上，即 3200μgOTFC 和 20mg 吗啡。该患者出现呼吸不足和饱和度低于 90%，需要低剂量纳洛酮。