Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
West J Nurs Res. 2022 Nov;44(11):1047-1056. doi: 10.1177/01939459211030336. Epub 2021 Aug 7.
Pain is a common complaint in the emergency department. An alternative to opioids is desirable. Oral medications are not feasible with gastrointestinal disorders or NPO. Intravenous medications require skill and time. Intravenous/intramuscular medications are painful with potential needlestick injury. Intranasal medications have rapid onset, easy administration, do not need skilled providers, and no risk of needlestick injury. A total of 28 adults with acute pain (numeric rating scale ≥ 4) received intranasal ketorolac. Numeric rating scale decreased in all: 32% complete pain relief, median (interquartile range) decrease -5 (-6.8 to -4) ( < .001). Pain relief onset was median [interquartile range] 5 (2.3, 15.0) min. Vital signs remained normal. There were no nasal mucosal changes, no complications. Minor side effects, mostly nasal burning, in 43%, resolved within 5 min. Patients and nurses were satisfied with intranasal ketorolac, and would use it again. Intranasal ketorolac had a rapid onset, was effective, safe, well tolerated with minor side effects that resolved quickly.
疼痛是急诊科常见的主诉。需要一种替代阿片类药物的方法。对于胃肠道疾病或禁食的患者，口服药物不可行。静脉内药物需要技巧和时间。静脉内/肌内药物注射疼痛，且有潜在的针刺伤风险。鼻内药物起效迅速，给药方便，不需要熟练的医护人员，也没有针刺伤的风险。总共 28 名急性疼痛（数字评分量表≥4）的成年人接受了鼻内酮咯酸治疗。所有患者的数字评分量表均有所下降：32%的患者完全缓解疼痛，中位数（四分位间距）下降-5（-6.8 至-4）（ < .001）。疼痛缓解的中位时间[四分位间距]为 5（2.3，15.0）分钟。生命体征保持正常。无鼻黏膜变化，无并发症。43%的患者出现轻微的副作用，主要为鼻烧灼感，5 分钟内缓解。患者和护士对鼻内酮咯酸均满意，并表示愿意再次使用。鼻内酮咯酸起效迅速，有效，安全，耐受性好，副作用轻微且迅速缓解。
