Bouida Wahid, Beltaief Kaouthar, Msolli Mohamed Amine, Ben Marzouk Maryem, Boubaker Hamdi, Grissa Mohamed Habib, Zorgati Asma, Methamem Mehdi, Boukef Riadh, Belguith Asma, Nouira Semir
Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.
Pain Pract. 2019 Mar;19(3):275-282. doi: 10.1111/papr.12736. Epub 2019 Feb 4.
To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain.
This is a single-blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30.
We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04).
Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.
评估分诊时开始的疼痛治疗对阿片类药物需求的影响，并评估急诊科（ED）急性疼痛患者的满意度。
这是一项在急诊科进行的单盲、随机、前瞻性研究。纳入的患者被随机分配接受单剂量口服安慰剂、对乙酰氨基酚或曲马多/对乙酰氨基酚组合药物。在分诊时给予方案治疗。主要结局是急诊留观期间对吗啡解救的需求。次要结局包括患者满意度、急诊留观时间以及急诊出院时视觉模拟评分（VAS）<30分的患者百分比。
我们纳入了1485例患者：安慰剂组496例，对乙酰氨基酚组497例，曲马多/对乙酰氨基酚组合组492例。各组在人口统计学和临床特征以及基线VAS疼痛评分方面相似。与安慰剂组和对乙酰氨基酚组相比，曲马多/对乙酰氨基酚组合组的吗啡解救需求显著降低（分别为11.5%、23.2%和18.9%；P = 0.03）。曲马多/对乙酰氨基酚组合组的患者满意度更高（分别为77%，对乙酰氨基酚组为69%，安慰剂组为68%）。安慰剂组84%的患者、对乙酰氨基酚组83%的患者以及曲马多/对乙酰氨基酚组合组87%的患者VAS评分<30分（对乙酰氨基酚组与曲马多/对乙酰氨基酚组合组之间P = 0.01）。对乙酰氨基酚组和曲马多/对乙酰氨基酚组合组的急诊留观时间为60分钟，安慰剂组为71分钟（P = 0.04）。
与服用对乙酰氨基酚的患者相比，分诊时早期给予口服曲马多/对乙酰氨基酚组合与静脉注射吗啡需求减少以及急诊急性疼痛患者满意度提高相关。未发现副作用显著增加。对于有类似益处需求的急诊科，可考虑这种干预措施。
