Sykora Roman, Kukackova Nikola, Sopko Ondrej, Peran David, Smetana Jiri, Renza Metodej, Kukacka Milos
Department of Anesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic.
Emergency Medical Services of Karlovy Vary Region, Zavodni 390/98C, Karlovy Vary, 36006, Czech Republic.
Eur J Trauma Emerg Surg. 2025 Sep 9;51(1):289. doi: 10.1007/s00068-025-02953-0.
In the Czech Republic, paramedics are required to consult a physician before administering intravenous opioids, which may delay effective prehospital pain management. As paramedic competencies expand in Europe, it is important to evaluate the safety and efficacy of independent opioid administration in prehospital emergency care settings.
To assess the safety and effectiveness of intravenous sufentanil administered independently by trained paramedics compared to administration following remote physician consultation in adult trauma patients.
Prospective, single-center, observational cohort study.
Conducted at the Emergency Medical Services of the Karlovy Vary Region between January 1 and December 31, 2024. The study included 462 adult trauma patients who were hemodynamically stable and conscious. Patients were divided into two groups: the Consultation group (physician consultation required) and the Competency group (paramedics administering independently).
Intravenous administration of sufentanil, with or without physician phone consultation.
Primary outcomes included reduction in pain (measured using the Numeric Rating Scale, NRS) and incidence of adverse events (e.g., respiratory depression, oxygen desaturation, hypotension, and antiemetic use). Statistical significance was set at p < 0.05.
Both groups achieved similar pain reduction. The Competency group received a higher mean dose of sufentanil (9.7 ± 3.0 µg vs. 8.9 ± 2.8 µg; p = 0.006) and more frequently used non-opioid adjuvant analgesics (54% vs. 41%). Documentation of pain scores was significantly better in the Competency group (87% vs. 43%; p < 0.01). Adverse events were rare, non-serious, and comparable between groups. Antiemetics were more frequently administered in the Competency group (11% vs. 6%; p = 0.037). A minor, clinically insignificant reduction in diastolic blood pressure was observed in the Competency group.
Intravenous sufentanil administered independently by trained paramedics in adult patients with lower severity trauma demonstrated safety and effectiveness comparable to administration following remote physician consultation, along with improved documentation and increased use of multimodal analgesia. Although this was a monocentric study, these observations may contribute to ongoing discussions about expanding paramedic competencies in opioid analgesia within the Czech prehospital emergency system.
在捷克共和国，护理人员在静脉注射阿片类药物前需要咨询医生，这可能会延迟有效的院前疼痛管理。随着欧洲护理人员能力的扩展，评估在院前急救环境中独立使用阿片类药物的安全性和有效性很重要。
评估经过培训的护理人员独立静脉注射舒芬太尼与在成人创伤患者中远程咨询医生后注射相比的安全性和有效性。
前瞻性、单中心、观察性队列研究。
于2024年1月1日至12月31日在卡罗维发利地区的紧急医疗服务中心进行。该研究纳入了462名血流动力学稳定且意识清醒的成年创伤患者。患者分为两组：咨询组（需要医生咨询）和能力组（护理人员独立给药）。
静脉注射舒芬太尼，有或没有医生电话咨询。
主要结果包括疼痛减轻（使用数字评分量表，NRS测量）和不良事件发生率（如呼吸抑制、氧饱和度降低、低血压和使用止吐药）。统计学显著性设定为p < 0.05。
两组疼痛减轻程度相似。能力组接受的舒芬太尼平均剂量更高（9.7±3.0μg对8.9±2.8μg；p = 0.006），且更频繁地使用非阿片类辅助镇痛药（54%对41%）。能力组疼痛评分的记录明显更好（87%对43%；p < 0.01）。不良事件很少见，不严重，且两组之间相当。能力组更频繁地使用止吐药（11%对6%；p = 0.037）。在能力组中观察到舒张压有轻微的、临床上无显著意义的降低。
经过培训的护理人员在病情较轻的成年创伤患者中独立静脉注射舒芬太尼显示出与远程咨询医生后给药相当的安全性和有效性，同时改善了记录并增加了多模式镇痛的使用。尽管这是一项单中心研究，但这些观察结果可能有助于在捷克院前急救系统中正在进行的关于扩大护理人员在阿片类镇痛方面能力的讨论。
