Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.
Department of Medicine, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2023 Aug;35(4):630-635. doi: 10.1111/1742-6723.14182. Epub 2023 Feb 19.
Redback spider (RBS) antivenom (RBSAV) use appears to have decreased since the results of the RAVE-2 antivenom efficacy study were released. The aims of this study were to assess change in RBSAV use over time and compare responses to treatment for antivenom and other analgesics.
Retrospective audit of RBS bite referrals to a toxicology unit, from January 2010 to January 2022. Data included demographics, pain severity, treatment (analgesia or RBSAV), response to treatment, re-presentation rate, adverse events, change in antivenom use over time.
Of 270 presentations, 157 with moderate or severe pain were included (RBSAV n = 51, analgesia n = 106). Median age was 39 years, n = 81 (51%) female. Those receiving antivenom were more likely to report severe pain n = 46/51 (84%) versus n = 68/106 (58%) (P = 0.006). Eighty-three percent of antivenom doses were administered between 2010 and 2013. Analgesia-only group received various combinations of paracetamol, NSAIDs, and opioids. In those receiving RBSAV, 17/48 (35%), 26/48 (54%), 5/48 (10%) reported a partial, complete or no reduction in pain, respectively, versus 30/77 (39%), 43/77 (58%) and 4/77 (5%), for analgesia-only group. Post-treatment pain was not recorded in three RBSAV and 28 analgesia-only patients. Pain reduction was no different for intravenous and intramuscular antivenom. Re-presentation for ongoing pain was more common in the analgesia-only group, 16/106 (15%) versus 1/51 (2%) for antivenom (P = 0.013).
Antivenom use fell over the study period. There was no difference in pain relief between RBSAV and analgesia-only groups. RBSAV, regardless of route of administration, was no better than standard analgesics in pain reduction in the present study.
自从 RAVE-2 抗蛇毒血清疗效研究的结果公布以来，红背蜘蛛（RBS）抗蛇毒血清（RBSAV）的使用似乎有所减少。本研究旨在评估随时间推移 RBSAV 使用的变化，并比较抗蛇毒血清和其他镇痛药的治疗反应。
对 2010 年 1 月至 2022 年 1 月期间毒理学单位收治的 RBS 咬伤患者进行回顾性审核。数据包括人口统计学、疼痛严重程度、治疗（镇痛或 RBSAV）、治疗反应、再次就诊率、不良反应、随时间推移抗蛇毒血清使用的变化。
在 270 例就诊中，纳入了 157 例中重度疼痛患者（RBSAV n=51，镇痛药 n=106）。中位年龄为 39 岁，n=81（51%）为女性。接受抗蛇毒血清治疗的患者更有可能报告重度疼痛 n=46/51（84%），而 n=68/106（58%）（P=0.006）。83%的抗蛇毒血清剂量是在 2010 年至 2013 年之间使用的。单独使用镇痛药的患者接受了各种组合的对乙酰氨基酚、非甾体抗炎药和阿片类药物。在接受 RBSAV 的患者中，17/48（35%）、26/48（54%）、5/48（10%）分别报告疼痛部分缓解、完全缓解和无缓解，而单独使用镇痛药的患者中，30/77（39%）、43/77（58%）和 4/77（5%）分别报告疼痛部分缓解、完全缓解和无缓解。三名接受 RBSAV 和 28 名单独使用镇痛药的患者未记录治疗后疼痛。静脉内和肌肉内抗蛇毒血清的疼痛缓解无差异。在单独使用镇痛药的患者中，持续疼痛再次就诊更为常见，16/106（15%），而接受抗蛇毒血清治疗的患者中，1/51（2%）（P=0.013）。
在研究期间，抗蛇毒血清的使用有所下降。RBSAV 组和单独使用镇痛药组的疼痛缓解无差异。在本研究中，RBSAV 无论给药途径如何，在减轻疼痛方面均不比标准镇痛药更好。
