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Opioids for Treatment of Pre-hospital Acute Pain : A Systematic Review

Opioids for Treatment of Pre-hospital Acute Pain : A Systematic Review


Title: Opioids for Treatment of Pre-hospital Acute Pain : A Systematic Review
Author: Friesgaard, Kristian Dahl
Vist, Gunn Elisabeth
Hyldmo, Per Kristian
Raatiniemi, Lasse
Kurola, Jouni
Larsen, Robert
Kongstad, Poul
Magnusson, Vidar
Sandberg, Mårten
Rehn, Marius
... 1 more authors Show all authors
Date: 2022-03
Language: English
Scope: 20
University/Institute: Landspitali - The National University Hospital of Iceland
Series: Pain and Therapy; 11(1)
ISSN: 2193-8237
DOI: https://doi.org/10.1007/s40122-021-00346-w
Subject: Svæfinga- og gjörgæslulæknisfræði; Acute pain; Emergency medicine; Opioids; Pre-hospital; Ópíóðar; Sjúkrahús; Analgesics, Opioid; Acute pain; Emergency medicine; Opioids; Pre-hospital; Ópíóðar; Sjúkrahús; Analgesics, Opioid; Neurology (clinical); Anesthesiology and Pain Medicine
URI: https://hdl.handle.net/20.500.11815/3015

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Citation:

Friesgaard , K D , Vist , G E , Hyldmo , P K , Raatiniemi , L , Kurola , J , Larsen , R , Kongstad , P , Magnusson , V , Sandberg , M , Rehn , M & Rognås , L 2022 , ' Opioids for Treatment of Pre-hospital Acute Pain : A Systematic Review ' , Pain and Therapy , vol. 11 , no. 1 , pp. 17-36 . https://doi.org/10.1007/s40122-021-00346-w

Abstract:

Introduction: Acute pain is a frequent symptom among patients in the pre-hospital setting, and opioids are the most widely used class of drugs for the relief of pain in these patients. However, the evidence base for opioid use in this setting appears to be weak. The aim of this systematic review was to explore the efficacy and safety of opioid analgesics in the pre-hospital setting and to assess potential alternative therapies. Methods: The PubMed, EMBASE, Cochrane Library, Centre for Reviews and Dissemination, Scopus, and Epistemonikos databases were searched for studies investigating adult patients with acute pain prior to their arrival at hospital. Outcomes on efficacy and safety were assessed. Risk of bias for each included study was assessed according to the Cochrane approach, and confidence in the evidence was assessed using the GRADE method. Results: A total of 3453 papers were screened, of which the full text of 125 was assessed. Twelve studies were ultimately included in this systematic review. Meta-analysis was not undertaken due to substantial clinical heterogeneity among the included studies. Several studies had high risk of bias resulting in low or very low quality of evidence for most of the outcomes. No pre-hospital studies compared opioids with placebo, and no studies assessed the risk of opioid administration for subgroups of frail patients. The competency level of the attending healthcare provider did not seem to affect the efficacy or safety of opioids in two observational studies of very low quality. Intranasal opioids had a similar effect and safety profile as intravenous opioids. Moderate quality evidence supported a similar efficacy and safety of synthetic opioid compared to morphine. Conclusions: Available evidence for pre-hospital opioid administration to relieve acute pain is scarce and the overall quality of evidence is low. Intravenous administration of synthetic, fast-acting opioids may be as effective and safe as intravenous administration of morphine. More controlled studies are needed on alternative routes for opioid administration and pre-hospital pain management for potentially more frail patient subgroups.

Description:

Funding Information: No funding or sponsorship was received for this study. The Rapid Service Fee was funded by the Scandinavian Society of Anaesthesia and Intensive care medicine (SSAI). Funding Information: The authors would like to thank Research Librarian Jane Kjemtrup Andersen for developing the search strategy and conducting the searches for this review. No funding or sponsorship was received for this study. The Rapid Service Fee was funded by the Scandinavian Society of Anaesthesia and Intensive care medicine (SSAI). All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria or authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. KDF was the main author drafting the manuscript, reviewing all articles, and extracting data for further analyses. GEV extracted the data and carried out the statistical analyses, helped with data interpretation, and assisted in drafting the manuscript. PKH was the supervisor of the study design and coordination, helped with reviewing of articles and data extraction and interpretation, and assisted in the drafting of the manuscript. LR, JK, RL, PK, VM, MS, and MR were all contributors to the study design and coordination, helped with data interpretation, and assisted in drafting the manuscript. LR was the main supervisor of the study design and coordination, reviewed all articles, conducted data extraction, interpreted data, and assisted in the manuscript drafting. All authors participated in discussion and decision on the PICOs and the methodology of this systematic review. All authors contributed to and approved the protocol (CRD42018114399) as well as the final manuscript. Kristian Dahl Friesgaard, Gunn Elisabeth Vist, Per Kristian Hyldmo, Lasse Raatiniemi, Jouni Kurola, Robert Larsen, Poul Kongstad, Vidar Magnusson, M?rten Sandberg, Marius Rehn, and Leif Rogn?s declare that they have no conflict of interest. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Publisher Copyright: © 2022, The Author(s).

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