Whitley Gregory Adam, Pilbery Richard
University of Lincoln: ORCID iD: https://orcid.org/0000-0003-2586-6815.
Yorkshire Ambulance Service NHS Trust: ORCID iD: https://orcid.org/0000-0002-5797-9788.
Br Paramed J. 2019 Dec 1;4(3):24-34. doi: 10.29045/14784726.2019.12.4.3.24.
Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain.
We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis.
From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting.
Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting.
受伤儿童的院前镇痛治疗并不理想，很少有疼痛儿童能得到镇痛治疗。研究已经确定了儿童院前疼痛管理的一些障碍，其中包括镇痛给药途径。本综述的目的是严格评估院前相关文献，探讨鼻内（IN）镇痛药对疼痛儿童的安全性和有效性。
我们进行了一项快速证据综述，检索了自数据库建库至2018年12月17日的CINAHL、MEDLINE和谷歌学术。我们纳入了在院前环境中接受任何鼻内镇痛药治疗的18岁以下疼痛儿童的研究。我们的观察指标为有效的疼痛管理，定义为疼痛评分降低≥2分（满分10分）、安全性和镇痛给药率。筛选和偏倚风险评估由两人独立进行。我们进行了叙述性综合分析。
在筛选的310篇文章中，23篇接受了全文评审，最终纳入10篇文章。未发现干预性研究。大多数论文报道了鼻内芬太尼（INF）的使用（n = 8），一篇报道了鼻内氯胺酮，另一篇报道了鼻内S-氯胺酮。叙述性综合分析表明，INF在减轻疼痛方面似乎是安全有效的；然而，其提高镇痛给药率的能力尚不清楚。鼻内氯胺酮和S-氯胺酮在提高镇痛给药率方面的有效性、安全性和能力尚不清楚。在这种情况下，没有证据表明鼻内二氢吗啡酮对儿童有效。
需要进行干预性研究，以更有把握地确定鼻内镇痛药（芬太尼、氯胺酮、S-氯胺酮、二氢吗啡酮）在院前环境中对儿童的有效性和安全性。
