Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
Klinik für Unfallchirurgie, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Bavaria, Germany.
BMC Anesthesiol. 2019 Jan 31;19(1):18. doi: 10.1186/s12871-019-0683-0.
Although pain treatment is an important objective in prehospital emergency medicine the incidence of oligoanalgesia is still high in prehospital patients. Given that prehospital emergency medicine in Germany is open for physicians of any speciality, the prehospital pain treatment may differ depending on the primary medical education. Aim of this study was to explore the difference in pain treatment between surgeons and anaesthesiologists in a physician staffed emergency medical service.
Retrospective single centre cohort analysis in a physician staffed ground based emergency medical service from January 2014 until December 2016. A total of 8882 consecutive emergency missions were screened. Primary outcome measure was the difference in application frequency of prehospital analgesics by anaesthesiologist or surgeon. Univariate and multivariate logistic regression analysis was used for statistical analysis including subgroup analysis for trauma and acute coronary syndrome.
A total of 8238 patients were included in the analysis. There was a significant difference in the application frequency of analgesics between surgeons and anaesthesiologists especially for opioids (p < 0.001, OR 0.68 [0.56-0.82]). Fentanyl was the most common administered analgesic in the trauma subgroup, but significantly less common used by surgeons (p = 0.005, OR 0.63 [0.46-0.87]). In acute coronary syndrome cases there was no significant difference in morphine administration between anaesthesiologists and surgeons (p = 0.49, OR 0.88 [0.61-1.27]).
Increased training for prehospital pain treatment should be implemented, since opioids were administered notably less frequent by surgeons than by anaesthesiologists.
尽管疼痛治疗是院前急救医学的一个重要目标，但院前患者的少镇痛现象仍很普遍。鉴于德国的院前急救医学对任何专业的医生都开放，因此院前急救的疼痛治疗可能因主要的医学教育背景而异。本研究旨在探讨由医生组成的急救医疗服务中，外科医生和麻醉师之间在院前疼痛治疗方面的差异。
这是一项回顾性单中心队列分析，在由医生组成的地面基础紧急医疗服务中进行，时间为 2014 年 1 月至 2016 年 12 月。共筛选了 8882 例连续急诊任务。主要观察指标是麻醉师和外科医生院前应用镇痛药物的频率差异。采用单变量和多变量逻辑回归分析进行统计分析，包括创伤和急性冠状动脉综合征亚组分析。
共纳入 8238 例患者进行分析。外科医生和麻醉师在镇痛药物的应用频率上存在显著差异，尤其是阿片类药物（p<0.001，OR 0.68[0.56-0.82]）。芬太尼是创伤亚组中最常用的镇痛药，但外科医生明显较少使用（p=0.005，OR 0.63[0.46-0.87]）。在急性冠状动脉综合征病例中，麻醉师和外科医生之间吗啡的使用没有显著差异（p=0.49，OR 0.88[0.61-1.27]）。
应加强院前疼痛治疗的培训，因为与麻醉师相比，外科医生明显较少使用阿片类药物。
