Sin Billy, Jeffrey Iain, Halpern Zachary, Adebayo Adebanke, Wing Tom, Lee Amy S, Ruiz Josel, Persaud Kevin, Davenport Lilia, de Souza Sylvie, Williams Mollie
Mount Sinai Queens, Department of Pharmacy Services, Long Island City, New York.
Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
J Emerg Med. 2019 Mar;56(3):301-307. doi: 10.1016/j.jemermed.2018.12.002. Epub 2019 Jan 9.
Patients in the United States frequently seek medical attention in the emergency department (ED) to address their pain. The intranasal (i.n.) route provides a safe, effective, and painless alternative method of drug administration. Sufentanil is an inexpensive synthetic opioid with a high therapeutic index and rapid onset of action, making it an attractive agent for management of acute pain in the ED.
The objective of our study was to evaluate the safety and efficacy of i.n. sufentanil as the primary analgesic for acute pain in the ED.
This was a single-center, prospective, randomized, double-blind, double-dummy, controlled trial that evaluated the use of i.n. sufentanil 0.7 μg/kg via mucosal atomizer device vs. intravenous morphine 0.1 mg/kg in adult patients who presented to the ED with acute pain. The primary outcome was patient's pain score at 10 min after administration of intervention. Secondary outcomes were adverse events, the need for rescue analgesia, and patient satisfaction after treatment.
Thirty patients were enrolled in each group. There was no significant difference in pain scores at 10 min after administration of intervention (sufentanil: 2.0, interquartile range = 2.0-3.3 vs. morphine: 3.0, interquartile range = 2.0-5.3, p = 0.198). No serious adverse events were reported. Rescue analgesia was not requested in either group. No significant difference in median satisfaction scores was found.
The use of i.n. sufentanil at 0.7 μg/kg/dose resulted in rapid and safe analgesia with comparable efficacy to i.v. morphine for up to 30 min in patients who presented with acute pain in the ED.
美国患者经常前往急诊科（ED）寻求疼痛治疗。鼻内（i.n.）给药途径提供了一种安全、有效且无痛的替代给药方法。舒芬太尼是一种价格低廉的合成阿片类药物，具有高治疗指数和快速起效的特点，使其成为急诊科急性疼痛管理的有吸引力的药物。
我们研究的目的是评估鼻内舒芬太尼作为急诊科急性疼痛主要镇痛药的安全性和有效性。
这是一项单中心、前瞻性、随机、双盲、双模拟、对照试验，评估通过黏膜雾化装置给予0.7μg/kg鼻内舒芬太尼与给予0.1mg/kg静脉注射吗啡对因急性疼痛就诊于急诊科的成年患者的疗效。主要结局是干预给药后10分钟时患者的疼痛评分。次要结局是不良事件、急救镇痛的需求以及治疗后患者满意度。
每组招募30例患者。干预给药后10分钟时疼痛评分无显著差异（舒芬太尼：2.0，四分位数间距=2.0 - 3.3；吗啡：3.0，四分位数间距=2.0 - 5.3，p = 0.198）。未报告严重不良事件。两组均未要求进行急救镇痛。中位满意度评分无显著差异。
对于在急诊科出现急性疼痛的患者，以0.7μg/kg/剂量使用鼻内舒芬太尼可快速、安全地镇痛，其疗效在长达30分钟内与静脉注射吗啡相当。
