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Hart K, Medvecz AJ, Vaidya A, Dusetzina S, Leech AA, Wiese AD. Opioid and non-opioid analgesic regimens after fracture and risk of serious opioid-related events. Trauma Surg Acute Care Open 2024; 9:e001364. [PMID: 39021730 PMCID: PMC11253739 DOI: 10.1136/tsaco-2024-001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Background Non-opioid analgesics are prescribed in combination with opioids among patients with long bone fracture to reduce opioid prescribing needs, yet evidence is limited on whether they reduce the risk of serious opioid-related events (SOREs). We compared the risk of SOREs among hospitalized patients with long bone fracture discharged with filled opioid prescriptions, with and without non-opioid analgesics. Design We identified a retrospective cohort of analgesic-naïve adult patients with a long bone fracture hospitalization using the Merative MarketScan Commercial Database (2013-2020). The exposure was opioid and non-opioid analgesic (gabapentinoids, muscle relaxants, non-steroidal anti-inflammatory drugs, acetaminophen) prescriptions filled in the 3 days before through 42 days after discharge. The outcome was the development of new persistent opioid use or opioid use disorder during follow-up (day 43 through day 408 after discharge). We used Cox proportional hazards regression with inverse probability of treatment weighting with overlap trimming to compare outcomes among those that filled an opioid and a non-opioid analgesic to those that filled only an opioid analgesic. In secondary analyses, we used separate models to compare those that filled a prescription for each specific non-opioid analgesic type with opioids to those that filled only opioids. Results Of 29 489 patients, most filled an opioid prescription alone (58.4%) or an opioid and non-opioid (22.0%). In the weighted proportional hazards regression model accounting for relevant covariates and total MME, filling both a non-opioid analgesic and an opioid analgesic was associated with 1.63 times increased risk of SOREs compared with filling an opioid analgesic only (95% CI 1.41 to 1.89). Filling a gabapentin prescription in combination with an opioid was associated with an increased risk of SOREs compared with those that filled an opioid only (adjusted HR: 1.84 (95% CI1.48 to 2.27)). Conclusions Filling a non-opioid analgesic in combination with an opioid was associated with an increased risk of SOREs after long bone fracture. Level of evidence Level III, prognostic/epidemiological. Study type Retrospective cohort study.
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Affiliation(s)
- Kyle Hart
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Medvecz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Avi Vaidya
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stacie Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley A Leech
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew D Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Tata TK, Ohene LA, Dzansi GA, Aziato L. Factors influencing nurses' pain assessment and management of road traffic casualties: a qualitative study at a military hospital in Ghana. BMC Emerg Med 2024; 24:100. [PMID: 38886656 PMCID: PMC11184758 DOI: 10.1186/s12873-024-01016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana. METHODS Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes. RESULTS Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management. CONCLUSIONS Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.
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Affiliation(s)
- Thomas Kwame Tata
- 37 Military Hospital, Neghelli Barracks Liberation Rd 37, Accra, Ghana
| | - Lillian Akorfa Ohene
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Ghana, P. O Box LG 43, Legon, Accra, Ghana.
| | - Gladys Akorfa Dzansi
- Department of Adult Health Nursing, School of Nursing and Midwifery of Ghana, P. O Box LG 43, Legon, Accra, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, PMB 31, Volta Region, Ho, Ghana
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Alser O, Dorken Gallastegi A, El Moheb M, Raybould T, DePesa C, Gervasini A, Flaherty M, Masiakos PT, Velmahos GC, Kaafarani H, Parks J. Outcomes of Combined Opioids and Benzodiazepines Consumption in Elderly Trauma: A Retrospective Cohort Study. Am Surg 2024:31348241259036. [PMID: 38836432 DOI: 10.1177/00031348241259036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Acute substance intoxication is associated with traumatic injury and worse hospital outcomes. The objective of this study was to evaluate the association between simultaneous opioids and benzodiazepines (OB) use and hospital outcomes in elderly trauma patients. METHODS We performed a retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 database. We included trauma patients (age ≥ 65 years) examined by urine toxicology within 24 hours of presentation. The primary outcome was in-hospital mortality. Secondary outcomes included hospital and ICU lengths of stay (HLOS AND ICULOS), in-hospital complications (eg, ventilator-associated pneumonia), unplanned intubation, and duration of mechanical ventilation. Patients were stratified being both positive for opioids and benzodiazepines (OB+) or not (OB-) based on having positive or negative drug screen for both drugs, respectively. A 1:1 propensity score matching was performed controlling for demographics (eg, age and sex), comorbidities (eg, alcoholism), and injury characteristics. RESULTS Of 77,311 tested patients, 849 OB+ were matched to OB- patients. Compared to OB- group, OB+ patients were more likely to have unplanned intubation (26 [3.1%] vs 8 [0.9%], P = 0.002) and had prolonged HLOS (≥2 days: 683 [84.0%] vs 625 [77.8%], P = 0.002). There were no differences in all other outcomes (P > 0.05). CONCLUSIONS The OB intake is associated with higher incidence of unplanned intubation and longer HLOS in elderly trauma patients. Early identification of elderly trauma patient with OB+ can help provide necessary pharmacologic and behavioral interventions to treat their substance use and potentially improve outcomes.
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Affiliation(s)
- Osaid Alser
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Toby Raybould
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher DePesa
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Alice Gervasini
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Flaherty
- Division of Pediatric Critical Care Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Peter T Masiakos
- Department of Pediatric Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Parks
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Muragizi J, Guptill M, Dumitriu BG, Henry MB, Aluisio AR, Nzabandora JP, Manirafasha A, Baird J, Morretti K, Karim N. Analgesia use in trauma patients at a university teaching hospital in Kigali, Rwanda. Afr J Emerg Med 2023; 13:147-151. [PMID: 37334174 PMCID: PMC10272278 DOI: 10.1016/j.afjem.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction While trends in analgesia have been identified in high-income countries, little research exists regarding analgesia administration in low- and middle-income countries (LMIC). This study evaluates analgesia administration and clinical characteristics among patients seeking emergency injury care at University Teaching Hospital-Kigali in Kigali, Rwanda. Methods This retrospective, cross-sectional study utilized a random sample of emergency center (EC) cases accrued between July 2015 and June 2016. Data was extracted from the medical record for patients who had an injury and were ≥ 15 years of age. Injury-related EC visits were identified by presenting complaint or final discharge diagnosis. Sociodemographic information, injury mechanism and type, and analgesic medications ordered and administered were analyzed. Results Of the 3,609 random cases, 1,329 met eligibility and were analyzed. The study population was predominantly male (72%) with a median age of 32 years and range between 15 and 81 years. In the studied sample, 728 (54.8%) were treated with analgesia in the EC. In unadjusted logistic regression, only age was not a significant predictor of receiving pain medication and was excluded from the adjusted analysis. In the adjusted model, all predictors remained significant, with being male, having at least one severe injury, and road traffic accident (RTA) as injury mechanism being significant predictors of analgesia administration. Conclusion In the study setting of injured patients in Rwanda, being male, involved in RTA or having more than one serious injury was associated with higher odds of receiving pain medication. Approximately half of the patients with traumatic injuries received pain medications, predominantly opioids with no factors predicting whether a patient would receive opioids versus other medications. Further research on implementation of pain guidelines and drug shortages is warranted to improve pain management for injured patients in the LMIC setting.
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Affiliation(s)
- Jean Muragizi
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Mindi Guptill
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Bogdan G. Dumitriu
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Michael B. Henry
- Columbia University-Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Jean Paul Nzabandora
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Appolinaire Manirafasha
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Janette Baird
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Katelyn Morretti
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Naz Karim
- Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Fu Y, Liu Q, Nie H. Efficacy of opioids for traumatic pain in the emergency department: a systematic review and Bayesian network meta-analysis. Front Pharmacol 2023; 14:1209131. [PMID: 37576822 PMCID: PMC10413574 DOI: 10.3389/fphar.2023.1209131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
Aim: To systematically assess and rank the efficacy of opioid medications for traumatic pain in the emergency department in terms of pain relief, adverse events and rescue analgesia. Methods: Four databases were systematically searched until 26 September 2022: PubMed, Embase, Cochrane Library, and Web of Science. Outcomes were pain relief, adverse events (dizziness, hypotension, pruritus, sedation), and rescue analgesia. For each outcome, network plots were drawn to exhibit direct and indirect comparisons, and rank probabilities were utilized to rank the efficacy of different opioids. Results: Twenty studies of 3,040 patients were eligible for this network meta-analysis. According to the rank probabilities, the top three analgesic medications for pain relief may be sufentanil (78.29% probability of ranking first), buprenorphine (48.54% probability of ranking second) and fentanyl (53.25% probability of ranking third); buprenorphine (31.20%), fentanyl (20.14%) and sufentanil (21.55%) were least likely to cause dizziness; the top three analgesic medications which were least likely to cause hypotension were buprenorphine (81.64%), morphine (45.02%) and sufentanil (17.27%); butorphanol (40.56%), morphine (41.11%) and fentanyl (14.63%) were least likely to cause pruritus; the top three medications which were least likely to cause sedation were hydrocodone + acetaminophen (97.92%), morphine (61.85%) and butorphanol (55.24%); patients who received oxycodone (83.64%), butorphanol (38.31%) and fentanyl (25.91%) were least likely to need rescue analgesia in sequence. Conclusion: Sufentanil, buprenorphine and fentanyl may be superior to other opioid medications in terms of pain relief and the incidence of dizziness, hypotension and pruritus, which might be selected as opioid analgesics for traumatic pain in the emergency setting.
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Affiliation(s)
- Yawen Fu
- Department of Emergency, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiang Liu
- Department of Emergency, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hu Nie
- Department of Emergency, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China
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Kuypers MI, Veldhuis LI, Mencl F, van Riel A, Thijssen WAHM, Tromp E, Goslings JC, Plötz FB. Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open 2023; 4:e12886. [PMID: 36704208 PMCID: PMC9867878 DOI: 10.1002/emp2.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 01/23/2023] Open
Abstract
Background Procedural sedation and analgesia (PSA) and peripheral nerve blocks (NBs) are techniques to manage pain and facilitate reduction of dislocated joints or fractures. However, it is unclear if either approach provides any distinct advantage in the emergency department (ED). The aim of this systematic review is to compare these 2 techniques on pain scores, adverse events, patient satisfaction, and length of stay (LOS) in the ED. Methods We performed an electronic search of MEDLINE, EMBASE, and the Cochrane Library, and references were hand-searched. Randomized controlled trials (RCTs) comparing PSA with NBs for orthopedic reductions in the ED were included. Outcomes of interest included pain scores, adverse events, patient satisfaction, and LOS in the ED. A total of 2 reviewers independently screened abstracts and extracted data into a standardized form. The Cochrane risk-of-bias tool was used to evaluate study quality. The Grading of Recommendation Assessment Development and Evaluation approach was used to assess the certainty and strength of the evidence. Data on pain scores were pooled using a random-effects model and are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results A total of 6 RCTs (n = 256) were included in a qualitative review, and 4 RCTs (n = 101) were included in the meta-analysis. There was no significant difference in pain scores between the PSA and NB groups (P = 0.47; SMD, 0.45; 95% CI, -0.78 to 1.69; I2 = 0.94). There were less adverse events in the NB group (0%-3.3%) compared with the PSA group (0%-20%; n = 256). LOS times were consistently shorter in the NB group (n = 215). Patient satisfaction was comparable in both groups (n = 196). Conclusion Based on the available evidence, NBs performed by emergency physicians are as effective as PSA in managing pain during orthopedic reductions in the ED. NBs are associated with fewer adverse events and shorter LOS in the ED. The quality of evidence is low.
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Affiliation(s)
- Maybritt I. Kuypers
- Department of Emergency MedicineAmsterdam University Medical Center location Academisch Medisch CentrumAmsterdamthe Netherlands
| | - Lars I. Veldhuis
- Department of AnesthesiologyAmsterdam University Medical Center location Academisch Medisch CentrumAmsterdamthe Netherlands
| | - Francis Mencl
- Department of Emergency MedicinePenn State University Milton Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Anne van Riel
- Department of Emergency MedicineCatharina ZiekenhuisEindhoventhe Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and StatisticsSint Antonius ZiekenhuisNieuwegeinthe Netherlands
| | - J. Carel Goslings
- Department of TraumatologyOnze Lieve Vrouwe GasthuisAmsterdamthe Netherlands
| | - Frans B. Plötz
- Department of PediatricsTergooi ZiekenhuisBlaricumthe Netherlands,Department of PediatricsAmsterdam UMC, Emma Children's HospitalAmsterdamthe Netherlands
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Ferri P, Gambaretto C, Alberti S, Parogni P, Rovesti S, Di Lorenzo R, Sollami A, Bargellini A. Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study. J Pain Res 2022; 15:3433-3445. [PMID: 36324866 PMCID: PMC9621014 DOI: 10.2147/jpr.s376586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief therapy. Patients and Methods A retrospective observational study was conducted in a sample including all adults treated by the professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019 to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27. Results The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2±22 years (range 18-108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36±0.9 vs post m = 4.18±2.2, p<0.001; medical cars pre m = 7.25±1.7 vs post m = 3.50±2.6, p<0.001). Subsequently, pain was only re-ascertained in 24.3% of subjects. Conclusion Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.
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Affiliation(s)
- Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Sara Alberti
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy,Correspondence: Sara Alberti, Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy, Tel +390592055599, Email
| | | | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rosaria Di Lorenzo
- Department of Mental Health and Drug Abuse, AUSL of Modena, Modena, Italy
| | - Alfonso Sollami
- Health Professions Service, University Hospital of Parma, Parma, Italy
| | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Wolfarth B, Speed C, Raymuev K, Vanden Bossche L, Migliore A. Managing pain and inflammation associated with musculoskeletal disease: time for a change? Curr Med Res Opin 2022; 38:1695-1701. [PMID: 35916625 DOI: 10.1080/03007995.2022.2108618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Bernd Wolfarth
- Department of Sports Medicine, Charité University Hospital and Professor, Humboldt University, Berlin, Germany
| | - Cathy Speed
- Department of Rheumatology, Sport & Exercise Medicine, Spire Cambridge Lea Hospital, Cambridge, UK
| | - Kirill Raymuev
- Department of Rheumatology, North-Western State Medical University I.I. Mechnikov, St Petersburg, Russia
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Alberto Migliore
- Department of Medicine, St Peter Fatebenefratelli Hospital, Rome, Italy
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Schnadthorst PG, Lankes C, Schulze C. [Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022:10.1007/s00113-022-01195-8. [PMID: 35849146 DOI: 10.1007/s00113-022-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used. OBJECTIVE The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine. MATERIAL AND METHODS A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research). RESULTS In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias. CONCLUSION In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
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Affiliation(s)
| | - Celine Lankes
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Christoph Schulze
- Zentrum für Sportmedizin der Bundeswehr, Dr.-Rau-Allee 32, 48231, Warendorf, Deutschland
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
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de Sire A, Marotta N, Lippi L, Scaturro D, Farì G, Liccardi A, Moggio L, Letizia Mauro G, Ammendolia A, Invernizzi M. Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111208. [PMID: 34833426 PMCID: PMC8618079 DOI: 10.3390/medicina57111208] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
- Correspondence: ; Tel.: +39-0961712819
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Dalila Scaturro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Giacomo Farì
- Motor and Sports Sciences, Department of Sciences and Biological and Environmental Technologies, Salento University, 73100 Lecce, Italy;
| | - Alfonso Liccardi
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Giulia Letizia Mauro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Management of Acute Pain Due to Traumatic Injury in Patients with Chronic Pain and Pre-injury Opioid Use. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Hachimi-Idrissi S, Dobias V, Hautz WE, Leach R, Sauter TC, Sforzi I, Coffey F. Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: management and recommendations. Intern Emerg Med 2020; 15:1141-1155. [PMID: 32930964 DOI: 10.1007/s11739-020-02411-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Europe, healthcare systems and education, as well as the clinical care and health outcomes of patients, varies across countries. Likewise, the management of acute events for patients also differs, dependent on the emergency care setting, e.g. pre-hospital or emergency department. There are various barriers to adequate pain management and factors common to both settings including lack of knowledge and training, reluctance to give opioids, and concerns about drug-seeking behaviour or abuse. There is no single current standard of care for the treatment of pain in an emergency, with management based on severity of pain, injury and local protocols. Changing practices, attitudes and behaviour can be difficult, and improvements and interventions should be developed with barriers to pain management and the needs of the individual emergency setting in mind. METHODS With these principles at the forefront, The European Society for Emergency Medicine (EUSEM) launched a programme-the European Pain Initiative (EPI)-with the aim of providing information, advice, and guidance on acute pain management in emergency settings. RESULTS AND CONCLUSIONS This article provides treatment recommendations from recently developed guidelines, based on a review of the literature, current practice across Europe and the clinical expertise of the EPI advisors. The recommendations have been developed, evaluated, and refined for both adults and children (aged ≥ 1 year, ≤ 15 years), with the assumption of timely pain assessment and reassessment and the possibility to implement analgesia. To provide flexibility for use across Europe, options are provided for selection of appropriate pharmacological treatment.
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Affiliation(s)
- Saïd Hachimi-Idrissi
- Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | | | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Robert Leach
- Department of Emergency Medicine Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | | | - Frank Coffey
- Nottingham University Hospitals' NHS Trust, Nottingham, UK
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Hachimi-Idrissi S, Coffey F, Hautz WE, Leach R, Sauter TC, Sforzi I, Dobias V. Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines-part 1: assessment. Intern Emerg Med 2020; 15:1125-1139. [PMID: 32930965 DOI: 10.1007/s11739-020-02477-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
Pain management is a vital component of patient care, particularly in the emergency setting. Pain can hinder the opportunities to treat and manage pain-causing conditions and remains one of the primary reasons patients seek emergency medical care, yet despite this, pain often remains under-acknowledged, under-assessed and undertreated. Despite the importance of effective management of acute pain, there are currently no well-defined emergency medicine guidelines at a European level to support healthcare professionals in achieving this goal. The European Society for Emergency Medicine (EUSEM) identified this as a significant unmet requirement, for improving day-to-day patient management and for providing guidance to trainees and non-emergency medicine physicians. Under the auspices of EUSEM, a programme-the European Pain Initiative-was launched with the aim of providing information, advice and guidance on pain management in pre-hospital and emergency department settings. Search terms were developed to search MEDLINE, Cochrane database, Google Scholar and EMBASE online databases to return English language articles published in the last 10 years. A working package of reference materials was evaluated against inclusion and exclusion criteria and levels of evidence ascribed. A short survey was developed by the European Pain Initiative Steering Committee for completion by EUSEM members to evaluate actual clinical practice. A working document of > 800 publications was identified for further review and evaluation against agreed criteria. Some further publications were included by the Steering Committee to explore older literature for long-established analgesics, or newly emergent literature that was considered important for inclusion but was identified as the guideline development was underway. This article provides the methodology used to inform the guidelines, including survey results of EUSEM members on assessment and treatment of acute pain. A companion manuscript in this issue presents an evidence-based review and recommendations for individualised evaluation of acute pain in patients in emergency settings.
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Affiliation(s)
- Saïd Hachimi-Idrissi
- Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Frank Coffey
- Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Robert Leach
- Department of Emergency Medicine, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
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Gholami M, Torabi Davan S, Gholami M, Bolandparvaz S, Gholami M, Chamanpara P, Shayan L. Effects of Topical Sesame Oil Extracted from Tahini ( Ardeh) on Pain Severity in Trauma Patients: A Randomized Double-Blinded Placebo-Controlled Clinical Trial. Bull Emerg Trauma 2020; 8:179-185. [PMID: 32944578 PMCID: PMC7468223 DOI: 10.30476/beat.2020.82561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. Methods This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, from May the 1st through November 30th, 2016. The patients were randomly assigned to two groups using block randomization. The intervention group received topical sesame oil extracted from tahini (Ardeh) and the placebo group received cooking oil. Pain severity, pain sensitivity and heaviness of painful site were assessed. Results Overall, we included 90 patients with traumatic limb injuries in this study who were randomized to two study groups. The mean age of the patients was 28.3 ± 6.8 (ranging from 25 to 35) years and there were 63 (70%) men and 27 (30%) women among the patients. In the sesame oil group, the mean changes in the pain severity (-1.53 ± 0.57, P<0.001), pain sensitivity (-1.45 ± 0.64, P<0.001) and heaviness of painful site (-1.56 ± 0.68, P<0.001) were significantly lower when compared to the placebo group in the second day of the intervention. None of the patients experience adverse drug effects. Conclusion Our findings suggest that the topical use of sesame oil extracted from Tahini has a pain reliever effect on the skin after bruising and it helps prevent skin discoloration in patients with traumatic injuries of limbs.
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Affiliation(s)
- Maryam Gholami
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Torabi Davan
- Transplantation Unit, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Gholami
- Intensive Care Unit, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bolandparvaz
- Trauma Research Center, Department of Surgery, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnaz Gholami
- School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Cognitive Neuroscience, Institute for Cognitive Science Studies, Shahid Beheshti University, Tehran, Iran; Cognitive Science (Brain, Mind, and Education), Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Parisa Chamanpara
- Clinical Research Development Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Lourens A, Parker R, Hodkinson P. Prehospital acute traumatic pain assessment and management practices in the Western Cape, South Africa: a retrospective review. Int J Emerg Med 2020; 13:21. [PMID: 32370807 PMCID: PMC7201999 DOI: 10.1186/s12245-020-00278-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Trauma is a common aetiology of acute pain in the emergency setting, and traumatic injuries have been recognised as a global public health crisis leading to numerous deaths and disabilities. This study aimed to identify the prevalence of acute pain among high acuity trauma patients presenting to a public sector emergency medical service and to describe prehospital acute traumatic pain assessment and management practices amongst emergency care providers in the Western Cape Province, South Africa. METHODS A retrospective review of electronic patient care reports of trauma patients treated by the South African Western Cape Emergency Medical Services between January 1 and December 31, 2017 was conducted. Stratified random sampling was utilised to select 2401 trauma patients out of 24,575 that met the inclusion criteria. RESULTS Of the 2401 patients reviewed, 435 (18.1%) had a pain score recorded, of which 423 (97.2%) were experiencing pain. An additional 8.1% (n = 194) of patients had pain or tenderness mentioned in the working diagnosis but no pain score noted. Eighty-one (18.6%) patients experienced mild pain, 175 (40.2%) moderate pain and 167 (38.2%) severe pain. No association was found between a pain score recorded and age group (≤ 14 versus > 14 years) (p = 0.649) or gender (p = 0.139). Only 7.6% of patients with moderate-to-severe pain and 2.8% of all trauma patients received any form of analgesic medication. No association was found between the administration of analgesia and age group (≤ 14 versus > 14 years) (p = 0.151) or gender (p = 0.054). Patients were more likely to receive analgesia if they had a pain score recorded (p < 0.001), were managed by advanced life support practitioners (p < 0.001) or had severe pain (p = 0.001). CONCLUSION Acute trauma pain assessment and management practices in this prehospital cohort are less well established than reported elsewhere and whether this reflects emergency care training, institutional culture, scopes of practice or analgesic resources, requires further research. Emergency medical services need to monitor and promote quality pain care, enhance pain education and ensure that all levels of emergency care providers have access to analgesic medication approved for prehospital use. Clear and rational guidelines would enable better pain management by all cadres of providers, for all levels of pain.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, South Africa
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Saranteas T, Kostroglou A, Anagnostopoulos D, Giannoulis D, Vasiliou P, Mavrogenis AF. Pain is vital in resuscitation in trauma. SICOT J 2019; 5:28. [PMID: 31414982 PMCID: PMC6694744 DOI: 10.1051/sicotj/2019028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.
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Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Anagnostopoulos
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Giannoulis
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Pantelis Vasiliou
- Fourth Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Khosa AH, Durrani HD, Wajid W, Khan M, Hussain MI, Haider I, Gulnaz M, Butool S. Choice of Analgesia in Patients with Critical Skeletal Trauma. Cureus 2019; 11:e4694. [PMID: 31338269 PMCID: PMC6639069 DOI: 10.7759/cureus.4694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The adequate management of thoracic trauma requires a systematic approach including pain control, respiratory therapy, and mobility achieved by surgical fixation. Failure to achieve pain control prolongs hospital stay. There are several options for achieving analgesia including epidural catheters, intravenous narcotics, intercostal, paravertebral or interpleural blocks, oral opioids, or simply a combination of the aforementioned interventions. In this study, we aim to compare the efficacy of thoracic epidural analgesia with systemic analgesia in patients with polytrauma. Methods This prospective study was conducted in the intensive care unit (ICU) of District Headquarters Hospital in Dera Ghazi Khan, Pakistan. Patients of age ≥18 years with skeletal trauma - rib fractures, limb fractures, and pelvic fractures - were included in the study. Group A patients were given epidural - bupivacaine and tramadol. Group B patients were given systemic analgesia with intravenous opioids. The severity of pain was assessed on the visual analogue scale (VAS) at time 0, 24 hours, and 48 hours. Data was entered and analysis was performed using Statistical Package for Social Sciences version 22.0. Results At 24 hours and 48 hours interval, group A showed a lower mean VAS score than group B (p = 0.74; p = 0.03). Group A required lesser mean doses of additional short-acting analgesics than group B (4.87 ± 1.06 vs. 6.77 ± 1.44; p < 0.0001). In Group A, 94% were discharged and the mortality rate was 6%; in group B, 86% were discharged and the mortality rate was 14% (p = 0.21). Conclusion Epidural analgesia provides better pain relief and requires fewer short-acting supplementing analgesics as compared to systemic analgesia in patients with multi-trauma.
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Affiliation(s)
- Abrar H Khosa
- Critical Care, District Headquarter Teaching Hospital, Dera Ghazi Khan, PAK
| | - Haq Dad Durrani
- Anesthesiology, D.G Khan Medical College, Dera Ghazi Khan, PAK
| | - Wafa Wajid
- Internal Medicine - Critical Care, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Maria Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Imran Haider
- Orthopedic Surgery, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Mahrukh Gulnaz
- Critical Care, District Headquarter Hospital, Dera Ghazi Khan, PAK
| | - Shahla Butool
- Internal Medicine, District Headquarter Hospital, Dera Ghazi Khan, PAK
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Dißmann PD, Maignan M, Cloves PD, Gutierrez Parres B, Dickerson S, Eberhardt A. A Review of the Burden of Trauma Pain in Emergency Settings in Europe. Pain Ther 2018; 7:179-192. [PMID: 29860585 PMCID: PMC6251834 DOI: 10.1007/s40122-018-0101-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 12/16/2022] Open
Abstract
Trauma pain represents a large proportion of admissions to emergency departments across Europe. There is currently an unmet need in the treatment of trauma pain extending throughout the patient journey in emergency settings. This review aims to explore these unmet needs and describe barriers to the delivery of effective analgesia for trauma pain in emergency settings. A comprehensive, qualitative review of the literature was conducted using a structured search strategy (Medline, Embase and Evidence Based Medicine Reviews) along with additional Internet-based sources to identify relevant human studies published in the prior 11 years (January 2006-December 2017). From a total of 4325 publications identified, 31 were selected for inclusion based on defined criteria. Numerous barriers to the effective treatment of trauma pain in emergency settings were identified, which may be broadly defined as arising from a lack of effective pain management pan-European and national guidelines, delayed or absent pain assessment, an aversion to opioid analgesia and a delay in the administration of analgesia. Several commonly used analgesics also present limitations in the treatment of trauma pain due to the routes of administration, adverse side effect profiles, pharmacokinetic properties and suitability for use in pre-hospital settings. These combined barriers lead to the inadequate and ineffective treatment of trauma pain for patients. An unmet need therefore exists for novel forms of analgesia, wider spread use of available analgesic agents which overcome some limitations associated with several treatment options, and the development of protocols for pain management which include patient assessment of pain.Funding: Mundipharma International Ltd.
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Affiliation(s)
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, CHUGA, Grenoble, France
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Leigheb M, Sabbatini M, Baldrighi M, Hasenboehler EA, Briacca L, Grassi F, Cannas M, Avanzi G, Castello LM. Prospective analysis of pain and pain management in an emergency department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:19-30. [PMID: 29083349 DOI: 10.23750/abm.v88i4 -s.6790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
. BACKGROUND AND AIM OF THE WORK The aim of pain management in the Emergency Department (ED) is to temporarily optimize patient quality of life by reducing acute discomfort. The goals of this study were to evaluate the intensity and location of pain experienced by patients in the ED, the time to analgesia administration in the ED, and the patient's satisfaction so to identify potential useful interventions to improve pain management. METHODS We prospectively collected data on the intensity of pain experienced by 137 patients during their ED stays using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Patients were further stratified by pain intensity according to three categories, and by cause of pain. RESULTS NRS pain measurements were higher than VAS measurements. Patients who took pain medication within a few hours before their ED visit had a higher mean VAS score at arrival in comparison to patients who did not. Patients treated with pain medications, compared to the non-treated, had more pain at arrival; abdominal pain was treated earlier than non-abdominal pain, whereas no difference in timing of medication administration was noted between traumatic and non-traumatic pain. Among the hospitalized patients, the chest was the most common location of pain; these patients had lower NRS scores than non-hospitalized patients. Patients with mild to moderate pain were more satisfied then those with severe pain. CONCLUSIONS The discrepancy between NRS and VAS scores suggests that pain intensity cannot be determined accurately according to pain scale data alone but should also incorporate clinical judgment.
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Sabzevari A, Kianifar H, Jafari SA, Saeidi M, Ahanchian H, Kiani MA, Jarahi L. The effect of music on pain and vital signs of children before and after endoscopy. Electron Physician 2017; 9:4801-4805. [PMID: 28894538 PMCID: PMC5586996 DOI: 10.19082/4801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background and Aim Gentle music has relaxing and pain reducing effects. In this study, the effect of music on patients’ vital signs and pain was investigated before and after endoscopy. Methods This clinical trial study was conducted on 100 children from seven to fourteen years of age in Gha’em Hospital, Mashhad in 2015. Children were divided into two equal groups (case group=50 and control group=50). The control group received endoscopy according to the standards, without any other procedure. For the case group, a classic musical piece by Clayderman was played during endoscopy (from the time of entering the endoscopy room to the end of the process). After conducting endoscopy, FALCC scale and Baker-Wong pain scale were filled for both groups. In addition, children’s vital signs including: heart rate (pulse), diastolic and systolic blood pressure were measured before and after endoscopy for both groups. Data analysis was conducted using SPSS16 with the help of Mann-Whitney and Chi-square tests. Results No significant difference was found in age, gender distribution of case or control groups (p>0.05). Heart rate and diastolic blood pressure was significantly lower in the music (case) group compared to the control group before endoscopy (p=0.012). In addition, pain score in patients of the music group was lower than the control group (p<0.05). Conclusion Playing music for children during endoscopy can reduce pain and anxiety in patients before and after endoscopy.
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Affiliation(s)
- Alireza Sabzevari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Kianifar
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Jafari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masumeh Saeidi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Ahanchian
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ali Kiani
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Leigheb M, Sabbatini M, Baldrighi M, Hasenboehler EA, Briacca L, Grassi F, Cannas M, Avanzi G, Luigi Mario C. Prospective analysis of pain and pain management in an emergency department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88. [PMID: 29083349 PMCID: PMC6357652 DOI: 10.23750/abm.v88i4-s.6790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
. BACKGROUND AND AIM OF THE WORK The aim of pain management in the Emergency Department (ED) is to temporarily optimize patient quality of life by reducing acute discomfort. The goals of this study were to evaluate the intensity and location of pain experienced by patients in the ED, the time to analgesia administration in the ED, and the patient's satisfaction so to identify potential useful interventions to improve pain management. METHODS We prospectively collected data on the intensity of pain experienced by 137 patients during their ED stays using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Patients were further stratified by pain intensity according to three categories, and by cause of pain. RESULTS NRS pain measurements were higher than VAS measurements. Patients who took pain medication within a few hours before their ED visit had a higher mean VAS score at arrival in comparison to patients who did not. Patients treated with pain medications, compared to the non-treated, had more pain at arrival; abdominal pain was treated earlier than non-abdominal pain, whereas no difference in timing of medication administration was noted between traumatic and non-traumatic pain. Among the hospitalized patients, the chest was the most common location of pain; these patients had lower NRS scores than non-hospitalized patients. Patients with mild to moderate pain were more satisfied then those with severe pain. CONCLUSIONS The discrepancy between NRS and VAS scores suggests that pain intensity cannot be determined accurately according to pain scale data alone but should also incorporate clinical judgment.
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Affiliation(s)
- Massimiliano Leigheb
- Department of Orthopaedics and Traumatology, University Hospital “Maggiore della carità”, Novara, Italy
| | - Maurizio Sabbatini
- Department of Science and Technology Innovation, Università del Piemonte Orientale, Alessandria, Italy,Correspondence: Maurizio Sabbatini, Dip. Scienze e Innovazione Tecnologica, Università del Piemonte Orientale UPO, via T. Michel 11 - 15121 Alessandria, Italy. Tel. +39 0131 360261, Fax +39 0131 360243; E-mail:
| | - Marco Baldrighi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Erik A. Hasenboehler
- Department of Orthopaedic Surgery Adult and Trauma Service, The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore MD, USA
| | - Luca Briacca
- Department of Emergency Medicine, University Hospital “Maggiore della carità”, Novara Italy
| | - Federico Grassi
- Department of Orthopaedics and Traumatology, University Hospital “Maggiore della carità”, Novara, Italy,Department of Health Sciences, Università del Piemonte Orientale, Italy
| | - Mario Cannas
- Department of Health Sciences, Università del Piemonte Orientale, Italy
| | - Giancarlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy,Department of Emergency Medicine, University Hospital “Maggiore della carità”, Novara Italy
| | - Castello Luigi Mario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy,Department of Emergency Medicine, University Hospital “Maggiore della carità”, Novara Italy
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