Benov Avi, Salas Margaux M, Nakar Helit, Antebi Ben, Tarif Bader, Yitzhak Avraham, Glassberg Elon
From the Israel Defense (B.A., T.B., Y.A., G.E.) Forces-Medical Corps (IDF-MC), Ramat Gan; Department of Surgery "A", Meir Medical Center (B.A.), Kfar Saba and the Sackler School of Medicine, Tel-Aviv University, Israel; USA Institute of Surgical Research, JBSA (S.M.M.), Fort Sam Houston, Texas; and Department of Military Medicine (TB), Hebrew University, Jerusalem, Israel.
J Trauma Acute Care Surg. 2017 Jul;83(1 Suppl 1):S150-S155. doi: 10.1097/TA.0000000000001481.
Pain control in trauma is an integral part of treatment in combat casualty care (CCC). More soldiers injured on the battlefield will need analgesics for pain than those who will need lifesaving interventions (LSI). It has been shown that early treatment of pain improves outcomes after traumatic injury, whereas inadequate treatment leads to higher rates of PTSD. The purpose of this article is to report the Israel Defense Forces Medical Corps (IDF-MC) experience with point of injury (POI) use of analgesia.
All cases documented in the IDF Trauma Registry (ITR) between January 1997 and December 2014 were examined. All cases of POI pain medications were extracted. Data collection included mechanism of injury, wound distribution, pain medication administered, mortality, and provider type.
Of 8,576 patients, 1,056 (12.3%) patients who had at least one documented pain management treatment were included in this study. Demographics of the study population included 94.2% men and 5.8% women with a median age of 21 years. Injury mechanisms included 40.3% blast injuries (n = 426) and 29% gunshot injuries (306). Of 1,513 injured body regions reported, 52% (787) were extremity wounds (upper and lower), 23% (353) were truncal wounds, and 17.7% (268) were head and neck injuries. A total of 1,469 episodes of analgesic treatment were reported. The most common types of analgesics were morphine (74.7%, 1,097 episodes), ketamine (9.6%, 141 episodes), and fentanyl (13.6%, 200 episodes). Of the patients, 39% (413) received more than one type of analgesic. In 90.5% of cases, analgesia was administered by a physician or a paramedic. Over the span of the study period (1997-2014), types of analgesics given by providers at POI had changed, as fentanyl was introduced to providers. A total of 801 LSIs were performed on 379 (35.9%) patients receiving analgesia, and no adverse events were found in any of the casualties.
Most casualties at POI did not receive any analgesics while on the battlefield. The most common analgesics administered at POI were opioids and the most common route of administration was intravenously. This study provides evidence that over time analgesic administration has gained acceptance and has been more common place on the battlefield. Increasingly, more casualties are receiving pain management treatment early in CCC along with LSIs. We hope that this shift will impact CCC by reducing PTSD and overall morbidity resulting from inadequate management of acute pain.
创伤疼痛控制是战斗伤员护理（CCC）治疗的一个组成部分。在战场上受伤的士兵中，需要镇痛药物止痛的人数比需要救命干预措施（LSI）的人数更多。研究表明，创伤后早期疼痛治疗可改善预后，而治疗不充分会导致创伤后应激障碍（PTSD）发生率升高。本文旨在报告以色列国防军医疗队（IDF-MC）在受伤点（POI）使用镇痛药物的经验。
对1997年1月至2014年12月以色列国防军创伤登记处（ITR）记录的所有病例进行检查。提取所有POI使用止痛药物的病例。数据收集包括损伤机制、伤口分布、使用的止痛药物、死亡率和提供者类型。
在8576例患者中，本研究纳入了1056例（12.3%）至少有一次记录在案的疼痛管理治疗的患者。研究人群的人口统计学特征包括94.2%为男性，5.8%为女性，中位年龄为21岁。损伤机制包括40.3%的爆炸伤（n = 426）和29%的枪伤（306）。在报告的1513个受伤身体部位中，52%（787）为四肢伤口（上肢和下肢），23%（353）为躯干伤口，17.7%（268）为头部和颈部损伤。共报告了1469次镇痛治疗。最常用的镇痛药物类型为吗啡（74.7%，1097次）、氯胺酮（9.6%，141次）和芬太尼（13.6%，200次）。在这些患者中，39%（413）接受了不止一种类型的镇痛药物。在90.5%的病例中，镇痛由医生或护理人员实施。在研究期间（1997 - 2014年），POI处提供者给予的镇痛药物类型发生了变化，因为芬太尼被引入供提供者使用。对379例（35.9%）接受镇痛治疗的患者进行了总共801次LSIs，未在任何伤员中发现不良事件。
大多数POI处的伤员在战场上未接受任何镇痛药物。POI处最常用的镇痛药物为阿片类药物，最常用的给药途径为静脉注射。本研究提供的证据表明，随着时间推移，镇痛药物的使用已得到认可，在战场上更为常见。越来越多的伤员在CCC早期与LSIs一起接受疼痛管理治疗。我们希望这种转变将通过减少急性疼痛管理不充分导致的PTSD和总体发病率来影响CCC。
