Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Swiss Air-Ambulance, Rega (Rettungsflugwacht / Guarde Aérienne), Zürich, Switzerland.
Scand J Trauma Resusc Emerg Med. 2021 Feb 17;29(1):36. doi: 10.1186/s13049-021-00852-y.
Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in the case of trauma. When there is mountainous topography, as in Switzerland, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders may improve overall treatment. We therefore assessed administration of nasal nalbuphine as an analgesic treatment for trauma patients in Switzerland.
This observational cohort study examined 267 patients who were treated with nasal nalbuphine by first responders in six ski resorts in Switzerland. All first responders were instructed to begin treatment by assessing the feasibility of using nalbuphine to treat pain in the patient. A treatment algorithm was developed and distributed to assure that nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of nalbuphine were collected on-site. Refills were handed out to the first responders with the return of each completed questionnaire.
Nalbuphine provided effective pain relief, with the median level of pain on the numeric rating scale for pain reduced by 3 units on average, from 8 points (p < 0.001). The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain levels. Nalbuphine was more effective in adolsecents than in patients aged 20 to 60 years (p = 0.006). No major side effects were observed.
Nasal administration of nalbuphine by first responders is a presumably safe and effective noninvasive pain management strategy for acutely injured patients in the prehospital setting. This may be an alternative, especially in the case of severe pain and prolonged time between arrival of the first responders and arrival of EMS/HEMS personnel on scene.
疼痛是院前环境中患者主要抱怨的症状之一，尤其是在创伤的情况下。在瑞士这样多山的地形中，从受伤到专业救援人员到达可能存在时间延迟，尤其是在滑雪道上。第一响应者给予安全的阿片类药物可能会改善整体治疗效果。因此，我们评估了在瑞士，第一响应者给予纳布啡鼻喷剂作为创伤患者的镇痛治疗。
本观察性队列研究纳入了瑞士六个滑雪胜地的 267 名接受第一响应者给予纳布啡鼻喷剂治疗的患者。所有第一响应者都被指示通过评估纳布啡治疗患者疼痛的可行性开始治疗。制定了治疗算法并分发，以确保仅按照严格的方案给予纳布啡。在现场收集有关疼痛评分和纳布啡给药后疼痛减轻的数据。每次完成问卷后，第一响应者都会收到纳布啡鼻喷剂的补充剂量。
纳布啡能有效缓解疼痛，平均数字评分量表上的疼痛评分中位数降低了 3 个单位，从 8 分（p<0.001）。多变量回归模型显示，初始疼痛水平较高的患者疼痛缓解更为明显。纳布啡在青少年中的效果比 20 至 60 岁的患者更为显著（p=0.006）。未观察到主要的副作用。
第一响应者给予纳布啡鼻喷剂是院前环境中急性受伤患者一种安全且有效的非侵入性疼痛管理策略。这可能是一种替代方案，尤其是在疼痛剧烈和第一响应者到达现场与 EMS/HEMS 人员到达之间时间延长的情况下。
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