Khoury Mansour, Caspi Sigalit, Stalnikowics Ruth, Peless Elad, Raiizman Ela, Salameh Shaden
Hebrew University Hadassah Medical School, Jerusalem, Israel.
Department of Emergency Medicine, Hadassah University Hospital Mount Scopus, Jerusalem, Israel.
Isr Med Assoc J. 2018 May;20(5):281-285.
Acute musculoskeletal pain is one of the most commonly reported symptoms among patients visiting the emergency department (ED). Treatment with over-the-counter pain medications, given by nurses, results in improved pain management and reduces the waiting time to drug administration without significant side effects. Opioid analgesics are extensively used for acute pain in the ED. Compared to morphine, oxycodone has a much more specific pharmacological activity, higher analgesic potential, and more tolerable side effects.
To assess the degree of pain reduction using different protocols, including dypirone and oxycodone given by nurses, in treating acute musculoskeletal pain in the emergency department (primary outcome) and to evaluate the need for rescue medications (secondary outcome).
This observational prospective clinical trial compared two groups of 50 patients, each one visiting the ED due to musculoskeletal pain. One group was treated with dipyrone syrup and the other was treated with oxycodone syrup. The primary outcome was pain reduction measured by the Numeric Rating Scale (NRS). The secondary outcome was the difference in need for rescue medications.
The reduction in the NRS was greater in the patients treated with oxycodone. This finding was statistically and clinically significant (P < 0.001). The need for rescue medications was also significantly reduced in this group of patients (P = 0.007).
This study showed that the administration of over-the-counter oxycodone syrup by nurses decreases the post-treatment pain reported by patients, reduces the need for rescue medications, and increases the satisfaction of the medical staff.
急性肌肉骨骼疼痛是急诊科就诊患者最常报告的症状之一。护士给予非处方止痛药进行治疗，可改善疼痛管理，减少给药等待时间，且无明显副作用。阿片类镇痛药在急诊科广泛用于急性疼痛。与吗啡相比，羟考酮具有更具特异性的药理活性、更高的镇痛潜力和更易耐受的副作用。
评估使用不同方案（包括护士给予的安乃近和羟考酮）治疗急诊科急性肌肉骨骼疼痛时的疼痛减轻程度（主要结局），并评估急救药物的需求（次要结局）。
这项观察性前瞻性临床试验比较了两组各50例因肌肉骨骼疼痛就诊急诊科的患者。一组接受安乃近糖浆治疗，另一组接受羟考酮糖浆治疗。主要结局是通过数字评分量表（NRS）测量的疼痛减轻情况。次要结局是急救药物需求的差异。
接受羟考酮治疗的患者NRS降低幅度更大。这一发现具有统计学和临床意义（P < 0.001）。该组患者对急救药物的需求也显著降低（P = 0.007）。
本研究表明，护士给予非处方羟考酮糖浆可降低患者报告的治疗后疼痛，减少急救药物需求，并提高医务人员的满意度。
