Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States.
Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
Am J Emerg Med. 2018 Sep;36(9):1603-1607. doi: 10.1016/j.ajem.2018.01.042. Epub 2018 Jan 16.
Pain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction.
This was a prospective study of patients 3-17 years with an isolated orthopedic injury presenting to a pediatric ED before and after instituting a triage-based pain guideline allowing for administration of INF by triage nurses. Our primary outcome was median TTA and secondary outcomes included the proportion of patients who received INF for pain, had unnecessary IV placement, and patient and parent satisfaction.
We enrolled 132 patients; 72 pre-guideline, 60 post-guideline. Demographics were similar between groups. Median TTA was not different between groups (34.5 min vs. 33 min, p = .7). Utilization of INF increased from 41% pre-guideline to 60% post-guideline (p = .01) and unnecessary IV placement decreased from 24% to 0% (p = .002). Patients and parents preferred the IN route for analgesia administration.
A triage-based pain protocol utilizing INF did not reduce TTA, but did result in increased INF use, decreased unnecessary IV placement, and was preferred by patients and parents to IV medication. INF is a viable analgesia alternative for children with isolated extremity injuries.
急诊科（ED）的疼痛管理指南可能会缩短镇痛药物的使用时间（TTA）。经鼻给予芬太尼（INF）是一种替代静脉给予阿片类药物的安全有效的方法。ED 疼痛管理指南中规定护士可以根据标准流程给予经鼻芬太尼（INF），其效果尚不清楚。本研究的目的是确定基于儿科 ED 分诊的疼痛方案，利用经鼻给予芬太尼（INF）对镇痛药物使用时间（TTA）以及患者和家长满意度的影响。
这是一项前瞻性研究，研究对象为因孤立性骨科损伤就诊于儿科 ED 的 3-17 岁患者，在引入允许分诊护士给予 INF 的基于分诊的疼痛指南前后进行。我们的主要结局是 TTA 的中位数，次要结局包括接受 INF 治疗疼痛的患者比例、不必要的静脉置管以及患者和家长的满意度。
共纳入 132 例患者；72 例为指南实施前，60 例为指南实施后。两组患者的人口统计学特征相似。两组 TTA 中位数无差异（34.5 分钟 vs. 33 分钟，p=0.7）。INF 的使用率从指南实施前的 41%增加到指南实施后的 60%（p=0.01），不必要的静脉置管从 24%降至 0%（p=0.002）。患者和家长更喜欢使用 IN 途径给予镇痛药物。
基于分诊的疼痛方案利用 INF 并未缩短 TTA，但增加了 INF 的使用，减少了不必要的静脉置管，并且比静脉给予药物更受患者和家长的欢迎。INF 是治疗孤立性四肢损伤儿童的一种可行的镇痛替代药物。
