Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
Montgomery County Hospital District EMS, Conroe, Texas.
J Emerg Med. 2024 Sep;67(3):e259-e267. doi: 10.1016/j.jemermed.2024.04.007. Epub 2024 May 3.
Parenteral ketorolac and intravenous (IV) acetaminophen have been used for prehospital analgesia, yet limited data exist on their comparative effectiveness.
To evaluate the comparative effectiveness of IV acetaminophen and parenteral ketorolac for analgesia in the prehospital setting.
We conducted a retrospective cross-sectional evaluation of patients receiving IV acetaminophen or parenteral ketorolac for pain management in a large suburban EMS system between 1/1/2019 and 11/30/2021. The primary outcome was change in first to last pain score. Subgroup analysis was performed on patients with traumatic pain. We used inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the treatment effect of acetaminophen versus ketorolac among all patients and the subgroup of those with traumatic pain.
Of 2178 patients included, 856 (39.3%) received IV acetaminophen and 1322 (60.7%) received parenteral ketorolac. The unadjusted mean change in pain score was -1.9 (SD 2.4) for acetaminophen group and -2.4 (SD 2.4) for ketorolac. In the propensity score analyses, there was no statistically significant difference in pain score change for the acetaminophen group versus ketorolac among all patients (mean difference, IPTW: 0.11, 95% confidence interval [CI] -0.16, 0.37; PSM: 0.15, 95% CI -0.13, 0.43) and among those with traumatic pain (unadjusted: 0.18, 95% CI -0.35, 0.72; IPTW: 0.23, 95% CI -0.25, 0.71; PSM: -0.03, 95% CI -0.61, 0.54).
We found no statistically significant difference in mean pain reduction of IV acetaminophen and parenteral ketorolac for management of acute pain.
在院前环境中，已将注射用酮咯酸和静脉内（IV）扑热息痛用于镇痛，但关于它们的相对有效性的数据有限。
评估 IV 扑热息痛和注射用酮咯酸在院前环境中用于镇痛的相对有效性。
我们对 2019 年 1 月 1 日至 2021 年 11 月 30 日期间在一个大型郊区 EMS 系统中接受 IV 扑热息痛或注射用酮咯酸治疗以进行疼痛管理的患者进行了回顾性横断面评估。主要结局是首次至最后一次疼痛评分的变化。对创伤性疼痛患者进行了亚组分析。我们使用逆概率治疗加权（IPTW）和倾向评分匹配（PSM）来估计所有患者和创伤性疼痛亚组中扑热息痛与酮咯酸治疗的效果。
在纳入的 2178 名患者中，856 名（39.3%）接受了 IV 扑热息痛治疗，1322 名（60.7%）接受了注射用酮咯酸治疗。扑热息痛组的疼痛评分平均变化为-1.9（SD 2.4），酮咯酸组为-2.4（SD 2.4）。在倾向评分分析中，在所有患者（平均差异，IPTW：0.11，95%置信区间[CI] -0.16，0.37；PSM：0.15，95%CI -0.13，0.43）和创伤性疼痛患者中（未调整：0.18，95%CI -0.35，0.72；IPTW：0.23，95%CI -0.25，0.71；PSM：-0.03，95%CI -0.61，0.54），扑热息痛组与酮咯酸组的疼痛评分变化无统计学意义。
我们发现，在管理急性疼痛方面，IV 扑热息痛和注射用酮咯酸的平均疼痛缓解程度无统计学差异。
