Wennberg Pär, Pakpour Amir, Broström Anders, Karlsson Kåre, Magnusson Carl
School of Health Sciences, Jönköping University, Jönköping, Sweden.
Ambulance Services, Skaraborg Hospital, Skövde, Sweden.
Prehosp Emerg Care. 2025;29(2):188-193. doi: 10.1080/10903127.2024.2363509. Epub 2024 Jun 12.
Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care.
This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE) - were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients' medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care.
During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was -4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period.
This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.
疼痛是院前急救中的常见症状，在此背景下进行疼痛治疗可能具有挑战性。虽然先前的研究评估了吗啡和其他合成阿片类药物在这种情况下用于疼痛管理的情况，但对阿芬太尼的评估有限。本研究的目的是评估在院前急救中由救护护士静脉注射阿芬太尼的安全性和效果。
这项回顾性观察研究连续纳入了2011年9月至2022年9月31日在瑞典紧急医疗服务机构接受阿芬太尼治疗的疼痛患者。关于不良事件（AE）、严重不良事件（SAE）发生的数据用于安全性评估，治疗前后使用视觉模拟量表（VAS）进行疼痛评分用于评估疼痛治疗效果。这些数据从电子患者病历数据库中提取进行分析。采用单因素逻辑回归分析确定院前急救中护士注射阿芬太尼后不良事件的显著预测因素。
在评估期间，17796例患者接受了阿芬太尼止痛治疗。2.5%的患者出现不良事件，25例（0.01%）被确定为严重不良事件。在5970例有完整疼痛VAS评分的患者中，治疗前VAS评分中位数为8（四分位间距3），治疗后为4（四分位间距3）。从阿芬太尼给药前到评估后，VAS测量的平均疼痛减轻为-4.1±2.6。给药频率在第一年增加，在评估期后期达到稳定水平。
本研究表明，阿芬太尼是院前急救中缓解急性疼痛的一种安全有效的替代药物。阿芬太尼在各种情况下都能有效缓解疼痛，谨慎给药时不良事件或严重不良事件的风险相对较低。
