Evidence-Based Guidelines for Prehospital Pain Management: Recommendations

作者：George Lindbeck, Manish I. Shah, Sabina Braithwaite, Jonathan R. Powell, Ashish R. Panchal, Lorin R. Browne, Eddy Lang, Brooke Burton, Jeffrey P. Coughenour, Remle P. Crowe, Hannah Degn, Mary S. Hedges, James J. Gasper, Kyle Guild, Connie J. Mattera, Sandra Nasca, Peter Taillac, M.P.N. Warth · 发表于：Prehospital Emergency Care · 年份：2021 · DOI：10.1080/10903127.2021.2018073 · 被引用次数：52 · 研究领域：Pediatric Pain Management Techniques、Anesthesia and Pain Management、Pain Management and Opioid Use

This project sought to develop evidence-based guidelines for the administration of analgesics for moderate to severe pain by Emergency Medical Services (EMS) clinicians based on a separate, previously published, systematic review of the comparative effectiveness of analgesics in the prehospital setting prepared by the University of Connecticut Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel (TEP) was assembled consisting of subject matter experts in prehospital and emergency care, and the development of evidence-based guidelines and patient care guidelines. A series of nine "patient/population-intervention-comparison-outcome" (PICO) questions were developed based on the Key Questions identified in the AHRQ systematic review, and an additional PICO question was developed to specifically address analgesia in pediatric patients. The panel made a strong recommendation for the use of intranasal fentanyl over intravenous (IV) opioids for pediatric patients without intravenous access given the supporting evidence, its effectiveness, ease of administration, and acceptance by patients and providers. The panel made a conditional recommendation for the use of IV non-steroidal anti-inflammatory drugs (NSAIDs) over IV acetaminophen (APAP). The panel made conditional recommendations for the use of either IV ketamine or IV opioids; for either IV NSAIDs or IV opioids; for either IV fentanyl or IV morphine; and for either IV k...