Department of Emergency and Critical Care Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Bachelor Programme in Paramedics, Institute of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.
Scand J Trauma Resusc Emerg Med. 2021 Dec 11;29(1):170. doi: 10.1186/s13049-021-00974-3.
Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology.
The systematic review includes studies from 2000 and up to 2020 that focus on children's prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results.
The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious.
The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.
在院前疼痛管理中，针对严重程度和药物不良反应，临床上有意义的疼痛缓解是尚未得到充分关注的领域。因此，本系统评价旨在全面检索数据库，研究在院前环境中治疗儿童急性疼痛时使用的更优药物，无论病因如何。
本系统评价纳入 2000 年及以后发表的研究，重点关注儿童院前疼痛管理。研究方案在 PROSPERO 注册，注册号为 CRD42019126699。纳入使用任何类型镇痛药物和所有给药途径的药物性疼痛管理。主要结局指标为（1）可测量的疼痛缓解（有效性）和（2）无任何严重不良事件发生。在 PubMed、Medline、Embase、CINAHL、Epistemonikos 和 Cochrane 图书馆中进行检索。最后，使用 Joanna Briggs 研究所（JBI）清单评估偏倚风险，并由于结果的异质性进行文字叙述性分析。
本系统评价共纳入 8 篇关于院前环境中儿童镇痛药物有效性和安全性的文章。大多数文章都确定了芬太尼（鼻内/静脉）、吗啡（静脉）、甲氧氟烷（吸入）和氯胺酮（静脉/肌内）等镇痛药物。评价了芬太尼、吗啡和甲氧氟烷的作用，所有纳入的镇痛药物均被评估为有效。也报道了芬太尼、甲氧氟烷和氯胺酮的不良事件，但均未被认为是严重的。
本系统评价显示，芬太尼、吗啡、甲氧氟烷和联合药物是院前环境中治疗儿童的有效镇痛药物。芬太尼、甲氧氟烷和氯胺酮给药后未报告严重不良事件。与其他镇痛药物相比，鼻内芬太尼和吸入性甲氧氟烷似乎是院前环境中儿童的首选药物，因为它们给药方便，作用和安全性相似。然而，纳入研究的证据水平（LOE）仅为 3 或 4 级，因此需要进一步研究。
