References
What is the most appropriate out-of-hospital opioid for adults with traumatic pain?
Abstract
Aims:
The aims of the current research were to investigate the most appropriate out-of-hospital opioid for adults with traumatic pain. Providing adequate analgesia has multiple benefits both during and post injury.
Methods:
The literature search was carried out using multiple databases to identify relevant out-of-hospital research with additional grey literature to support. The main themes encountered were intravenous morphine compared to intravenous fentanyl, and the contrast between them.
Discussion:
There were no significant differences in effectiveness or adverse effects. Intranasal application was thought to be favoured where intravenous access was unobtainable.
Conclusions:
Further research is required to establish which is the most appropriate opioid. This could include a greater focus on the onset time, duration and optimal dose. Increased education and organisational focus would need to be addressed alongside a change in drug formulary for the out-of-hospital clinician.
Trauma is often accompanied by pain—whether that is major trauma or a single injury (Association of Ambulance Chief Executives (AACE), 2016). Providing adequate analgesia to reduce this is a simple humanitarian aim (AACE, 2016). There have been considerable developments for this subset of patients over the past 25 years, such as the introduction of major trauma networks; however, there are still improvements that can be made (National Institute for Health and Care Excellence (NICE), 2016). One key clinical area highlighted by NICE (2016) is pain management in patients with traumatic injuries. NICE (2016) notes that those suffering pain should have immediate and effective pain relief and, without it, patients can experience delayed healing, chronic pain and disability.
Major trauma is a minor element of the total workload in emergency care, with estimations of less than 0.2% of the total workload (National Audit Office (NAO), 2010). Trauma such as dislocation, fracture, joint injury, and amputation were the second most common diagnoses in accident and emergency between 2015 and 2016 (Baker, 2017). The true costs of trauma are unknown when taking into account immediate and subsequent treatment, support, and loss of economic output (NAO, 2010; NICE, 2016). There is room for development in pain management as pain relief is often inadequately treated in traumatic injuries leading to oligoanalgesia, the undertreatment of pain (Parker and Rodgers, 2015).
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