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Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review

INTRODUCTION: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review i...

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Autores principales: Whitley, Gregory Adam, Pilbery, Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The College of Paramedics 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783922/
https://www.ncbi.nlm.nih.gov/pubmed/33447148
http://dx.doi.org/10.29045/14784726.2019.12.4.3.24
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author Whitley, Gregory Adam
Pilbery, Richard
author_facet Whitley, Gregory Adam
Pilbery, Richard
author_sort Whitley, Gregory Adam
collection PubMed
description INTRODUCTION: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain. METHODS: We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis. RESULTS: From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting. CONCLUSION: Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting.
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spelling pubmed-77839222021-01-13 Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review Whitley, Gregory Adam Pilbery, Richard Br Paramed J Literature Review INTRODUCTION: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain. METHODS: We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis. RESULTS: From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting. CONCLUSION: Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting. The College of Paramedics 2019-12-01 2019-12-01 /pmc/articles/PMC7783922/ /pubmed/33447148 http://dx.doi.org/10.29045/14784726.2019.12.4.3.24 Text en © 2019 The Author(s) https://creativecommons.org/licenses/by/2.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Literature Review
Whitley, Gregory Adam
Pilbery, Richard
Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title_full Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title_fullStr Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title_full_unstemmed Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title_short Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
title_sort pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review
topic Literature Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783922/
https://www.ncbi.nlm.nih.gov/pubmed/33447148
http://dx.doi.org/10.29045/14784726.2019.12.4.3.24
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