Deslandes Marvin, Deicke Martin, Grannemann Julia Johanna, Hinkelbein Jochen, Hoyer Annika, Kalmbach Matthias, Kobiella André, Strickmann Bernd, Plappert Thomas, Jansen Gerrit
Universitätsklinik für Anästhesiologie, Intensivmedizin und Notfallmedizin, Johannes Wesling Klinikum Minden, Ruhr Universität Bochum, Hans-Nolte-Straße 1, 32429, Minden, Deutschland.
Ärztliche Leitung Rettungsdienst, Landkreis Osnabrück, Am Schölerberg 1, 49082, Osnabrück, Deutschland.
Anaesthesiologie. 2024 Sep;73(9):583-590. doi: 10.1007/s00101-024-01449-7. Epub 2024 Aug 23.
Following recent changes to the German Narcotics Act, this article examines prehospital analgesia by paramedics using piritramide vs. nalbuphine + paracetamol.
Prehospital analgesia administered by paramedics from the Fulda (piritramide) and Gütersloh (nalbuphine + paracetamol) emergency services was compared regarding pain intensity at the beginning and end of the mission, measured using the numeric rating scale (NRS). Additionally, an analysis of the resulting complications was carried out.
In this study 2429 administrations of analgesia were evaluated (nalbuphine + paracetamol: 1635, 67.3%, initial NRS: 8.0 ± 1.4, end of NRS: 3.7 ± 2.0; piritramide: 794, 32.7%, initial NRS: 8.5 ± 1.1, end of NRS: 4.5 ± 1.6). Factors influencing NRS change were initial NRS (regression coefficient, RC: 0.7075, 95% confidence interval, CI: 0.6503-0.7647, p < 0.001), treatment with nalbuphine + paracetamol (RC: 0.6048, 95% CI: 0.4396-0.7700, p < 0.001). Treatment with nalbuphine + paracetamol (n = 796 (48.7%)) compared to piritramide (n = 190 (23.9%)) increased the odds of achieving NRS < 4 (odds ratio, OR: 2.712, 95% CI: 2.227-3.303, p < 0.001). Complications occurred in n = 44 (5.5%) with piritramide and in n = 35 (2.1%) with nalbuphine + paracetamol. Risk factors for complications were analgesia with piritramide (OR: 2.699, 95% CI: 1.693-4.301, p < 0.001), female sex (OR: 2.372, 95% CI: 1.396-4.029, p = 0.0014), and age (OR: 1.013, 95% CI: 1.002-1.025, p = 0.0232).
Compared with piritramide, prehospital analgesia with nalbuphine + paracetamol has favorable effects in terms of analgesic efficacy and complication rates and should therefore be considered in future recommendations for paramedics.
随着德国麻醉品法最近的修订，本文探讨了护理人员使用匹利卡明与纳布啡+对乙酰氨基酚进行院前镇痛的情况。
比较了富尔达（匹利卡明）和 Gütersloh（纳布啡+对乙酰氨基酚）急救服务部门护理人员进行的院前镇痛，通过数字评分量表（NRS）测量任务开始和结束时的疼痛强度。此外，对由此产生的并发症进行了分析。
本研究评估了2429次镇痛给药（纳布啡+对乙酰氨基酚：1635次，67.3%，初始NRS：8.0±1.4，结束时NRS：3.7±2.0；匹利卡明：794次，32.7%，初始NRS：8.5±1.1，结束时NRS：4.5±1.6）。影响NRS变化的因素有初始NRS（回归系数，RC：0.7075，95%置信区间，CI：0.6503 - 0.7647，p<0.001）、纳布啡+对乙酰氨基酚治疗（RC：0.6048，95%CI：0.4396 - 0.7700，p<0.001）。与匹利卡明（n = 190（23.9%））相比，纳布啡+对乙酰氨基酚治疗（n = 796（48.7%））使NRS<4的几率增加（优势比，OR：2.712，95%CI：2.227 - 3.303，p<0.001）。匹利卡明组有n = 44（5.5%）发生并发症，纳布啡+对乙酰氨基酚组有n = 35（2.
