Serra Sossio, Spampinato Michele Domenico, Riccardi Alessandro, Guarino Mario, Pavasini Rita, Fabbri Andrea, De Iaco Fabio
Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy.
Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy.
J Clin Med. 2023 Mar 30;12(7):2609. doi: 10.3390/jcm12072609.
This systematic review examined the efficacy and safety of intranasal fentanyl (INF) for acute pain treatment in children, adults, and the elderly in prehospital emergency services (PHES) and emergency departments (ED). ClinicalTrials.gov, LILACS, PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane databases were consulted until 31 December 2022. A total of 23 studies were included: 18 in children (1 PHES, 17 ED), 5 in adults (1 PHES, 4 ED) and 1 in older people (1 PHES subgroup analysis). In children, INF was effective in both settings and as effective as the comparator drugs, with no differences in adverse events (AEs); one randomised controlled trial (RCT) showed that INF was more effective than the comparator drugs. In adults, one study demonstrated the efficacy of INF in the PHES setting, one study demonstrated the efficacy of INF in the ED setting, two RCTs showed INF to be less effective than the comparator drugs and one RCT showed INF to be as effective as the comparator, with no difference in AEs reported. In older people, one study showed effective pain relief and no AEs. In summary, INF appears to be effective and safe in children and adults in PHES and ED. More high-quality studies are needed, especially in PHES and older people.
本系统评价考察了鼻内芬太尼（INF）在院前急救服务（PHES）和急诊科（ED）中用于儿童、成人及老年人急性疼痛治疗的有效性和安全性。检索了ClinicalTrials.gov、LILACS、PubMed、SCOPUS、EMBASE、谷歌学术和Cochrane数据库，检索截止至2022年12月31日。共纳入23项研究：18项针对儿童（1项在PHES，17项在ED），5项针对成人（1项在PHES，4项在ED），1项针对老年人（1项PHES亚组分析）。在儿童中，INF在两种环境下均有效，且与对照药物效果相当，不良事件（AE）无差异；一项随机对照试验（RCT）表明INF比对照药物更有效。在成人中，一项研究证明了INF在PHES环境中的有效性，一项研究证明了INF在ED环境中的有效性，两项RCT显示INF比对照药物效果差，一项RCT显示INF与对照药物效果相当，报告的AE无差异。在老年人中，一项研究显示疼痛缓解有效且无AE。总之，INF在PHES和ED中的儿童和成人中似乎有效且安全。需要更多高质量的研究，尤其是在PHES和老年人中。
