Emergency Department SAMU-SMUR 95, CHG Pontoise-Beaumont/Oise Pontoise.
Emergency Department, CHU Purpan, Toulouse.
Eur J Emerg Med. 2020 Dec;27(6):414-421. doi: 10.1097/MEJ.0000000000000686.
Oligo-analgesia is common in the emergency department (ED). This study aimed at reporting, when initiated by triage nurse, the superior efficacy of inhaled methoxyflurane plus standard of care (m-SoC) analgesia versus placebo plus SoC (p-SoC) for moderate-to-severe trauma-related pain in the hospital ED.
A randomised, double-blind, placebo-controlled trial was conducted at eight EDs. Adults with pain score ≥4 (11-point numerical rate scale, NRS) at admission were randomised to receive one or two inhalers containing m-SoC or p-SoC. Primary outcome measure was time until pain relief ≤30 mm, assessed on the 100-mm Visual Analogic Scale (VAS).
A total of 351 patients were analysed (178 m-SoC; 173 p-SoC). Median pain prior to first inhalation was 66 mm, 75% had severe pain (NRS 6-10). Median time to pain relief was 35 min [95% confidence interval (CI), 28-62] for m-SoC versus not reached in p-SoC (92 - not reached) [hazard ratio), 1.93 (1.43-2.60), P < 0.001]. Pain relief was most pronounced in the severe pain subgroup: hazard ratio, 2.5 (1.7-3.7). As SoC, 24 (7%) patients received weak opioids (6 versus 8%), 4 (1%) strong opioid and 44 (13%) escalated to weak or strong opioids (8 versus 17%, respectively, P = 0.02). Most adverse events were of mild (111/147) intensity.
In this study, we report that methoxyflurane, initiated at triage nurse as part of a multimodal analgesic approach, is effective in achieving pain relief for trauma patients. This effect was particularly pronounced in the severe pain subgroup.
急诊室（ED）中经常出现镇痛不足的情况。本研究旨在报告由分诊护士启动的吸入甲氧氟烷联合标准治疗（m-SoC）与安慰剂联合标准治疗（p-SoC）对中度至重度创伤相关疼痛的疗效，m-SoC 用于医院 ED。
在八个 ED 进行了一项随机、双盲、安慰剂对照试验。入院时疼痛评分≥4（11 点数字评分量表，NRS）的成年人被随机分配接受含有 m-SoC 或 p-SoC 的一个或两个吸入器。主要结局测量是疼痛缓解至≤30mm 的时间，使用 100mm 视觉模拟评分（VAS）进行评估。
共分析了 351 名患者（178 名 m-SoC；173 名 p-SoC）。首次吸入前的中位数疼痛为 66mm，75%的患者有严重疼痛（NRS 6-10）。m-SoC 组的中位疼痛缓解时间为 35 分钟[95%置信区间（CI），28-62]，而 p-SoC 组未达到缓解时间[92-未达到] [风险比]，1.93（1.43-2.60），P<0.001]。在严重疼痛亚组中，疼痛缓解最为明显：风险比，2.5（1.7-3.7）。作为 SoC，24 名（7%）患者接受了弱阿片类药物（6 名与 8 名），4 名（1%）强阿片类药物和 44 名（13%）升级为弱或强阿片类药物（8 名与 17 名，分别为，P=0.02）。大多数不良事件为轻度（111/147）。
在这项研究中，我们报告说，甲氧氟烷作为多模式镇痛方法的一部分，由分诊护士启动，可有效缓解创伤患者的疼痛。这种效果在严重疼痛亚组中尤为明显。
