Weldon Erin R, Ariano Robert E, Grierson Robert A
Prehosp Emerg Care. 2016;20(1):45-51. doi: 10.3109/10903127.2015.1056893. Epub 2015 Aug 17.
In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible. Once chest pain was confirmed, patients received oxygen, aspirin, and nitroglycerin therapy. If the ischemic-type chest pain continued the patient was randomized in a double-blinded fashion to treatment with either morphine or fentanyl. Pain scale scores, necessity for additional dosing, and rate of adverse events between the groups were assessed every 5 minutes and were compared using t-testing, Fisher's Exact test, or Analysis of Variance (ANOVA) where appropriate. The primary outcome of the study was incidence of hypotension and the secondary outcome was pain reduction as measured by the visual analog score and numeric rating score. A total of 207 patients were randomized with 187 patients included in the final analysis. Of the 187 patients, 99 were in the morphine group and 88 in the fentanyl group. No statistically significant difference between the two groups with respect to hypotension was found (morphine 5.1% vs. fentanyl 0%, p = 0.06). Baseline characteristics, necessity for additional dosing, and other adverse events between the two groups were not statistically different. There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in providing analgesia for ischemic-type chest pain. Fentanyl appears to be a safe and effective alternative to morphine for the management of chest pain in the prehospital setting.
在急性冠脉综合征的治疗中，减轻交感神经应激和儿茶酚胺释放是一个重要的治疗目标。实现这一目标的一种方法是通过全身给予镇痛药来减轻疼痛。从历史上看，吗啡一直是缺血性心脏病疼痛的首选镇痛药。这项随机双盲对照试验旨在证明芬太尼作为院前环境中缺血性胸痛的替代一线镇痛药的效用。在紧急医疗服务系统中因疑似缺血性胸痛接受治疗的连续患者被认为符合条件。一旦胸痛得到确认，患者接受氧气、阿司匹林和硝酸甘油治疗。如果缺血性胸痛持续，患者以双盲方式随机接受吗啡或芬太尼治疗。每5分钟评估一次两组之间的疼痛量表评分、额外给药的必要性和不良事件发生率，并在适当情况下使用t检验、Fisher精确检验或方差分析（ANOVA）进行比较。该研究的主要结局是低血压发生率，次要结局是通过视觉模拟评分和数字评分量表测量的疼痛减轻情况。共有207名患者被随机分组，187名患者纳入最终分析。在这187名患者中，99名在吗啡组，88名在芬太尼组。两组在低血压方面未发现统计学上的显著差异（吗啡组为5.1%，芬太尼组为0%，p = 0.06）。两组之间的基线特征、额外给药的必要性和其他不良事件在统计学上无差异。两组之间视觉模拟评分和数字评分量表评分的疼痛变化无显著差异（分别为p = 0.16和p = 0.15）。这项研究支持芬太尼和吗啡在为缺血性胸痛提供镇痛方面具有可比性。在院前环境中，芬太尼似乎是吗啡治疗胸痛的一种安全有效的替代药物。
