Long Island University, Arnold & Marie Schwartz College of Pharmacy & Health Sciences, United States 1 University Plaza, New York, NY, 11201, United States; Department of Pharmacy Services, Division of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, NY, United States.
Long Island University, Arnold & Marie Schwartz College of Pharmacy & Health Sciences, United States 1 University Plaza, New York, NY, 11201, United States; Department of Pharmacy Services, Division of Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, NY, United States.
Am J Emerg Med. 2018 Feb;36(2):310-318. doi: 10.1016/j.ajem.2017.11.043. Epub 2017 Nov 20.
Traditional routes for administration of pain medications include oral (PO), intravenous (IV), or intramuscular routes (IM). When these routes are not feasible, the intranasal (IN) route may be considered. The objectives of this evidence-based review were: to review the literature which compared the safety and efficacy of IN analgesia to traditional routes and to determine if IN analgesia should be considered over traditional routes for acute pain control in the ED.
The MEDLINE and EMBASE databases from July 1970 to July 2017 were searched. Randomized controlled trials (RCT) that evaluated the use of IN analgesia for acute pain in the ED were included. Methodological quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria.
Eleven randomized controlled trials (RCT) met the inclusion criteria. Four trials found significant reductions in pain scores, favoring IN analgesia. However, in all of the trials, pain relief was not sustained. Three trials reported superior pain reduction with comparators and three trials reported no statistical significance. One trial described effective pain relief with IN analgesia but did not provide data on statistical analysis.
Eleven randomized controlled trials with various methodological flaws revealed conflicting conclusions. There is limited evidence to support the use of the IN analgesia over traditional routes for acute pain in the ED. The IN route may be a good alternative in scenarios where IV access is not feasible, patients are refusing injectable medications, or a fast onset of pain relief is needed.
传统的疼痛药物给药途径包括口服（PO）、静脉内（IV）或肌肉内途径（IM）。当这些途径不可行时，可能会考虑鼻内（IN）途径。本循证综述的目的是：回顾比较 IN 镇痛与传统途径的安全性和疗效的文献，并确定 IN 镇痛是否应考虑用于 ED 急性疼痛控制而替代传统途径。
检索了 1970 年 7 月至 2017 年 7 月的 MEDLINE 和 EMBASE 数据库。纳入了评估 IN 镇痛用于 ED 急性疼痛的随机对照试验（RCT）。使用推荐评估、制定与评估分级标准（Grading of Recommendations Assessment, Development, and Evaluation criteria）评估试验的方法学质量。
11 项随机对照试验（RCT）符合纳入标准。四项试验发现 IN 镇痛可显著降低疼痛评分，但镇痛效果不持久。三项试验报告了 IN 镇痛与对照组相比有更好的镇痛效果，三项试验报告无统计学意义。一项试验描述了 IN 镇痛可有效缓解疼痛，但未提供统计分析数据。
11 项 RCT 存在各种方法学缺陷，得出的结论相互矛盾。有有限的证据支持在 ED 中，与传统途径相比，IN 镇痛可用于急性疼痛。在 IV 通路不可行、患者拒绝注射药物或需要快速缓解疼痛的情况下，IN 途径可能是一个较好的替代方案。
