急诊科(ED)的疼痛管理指南可能会缩短镇痛时间(TTA)。鼻内芬太尼(INF)是静脉阿片类药物的安全有效替代品。尚不清楚ED疼痛管理指南提供护士开始鼻内芬太尼(INF)给药的常规命令的效果。这项研究的目的是确定使用鼻内芬太尼(INF)的基于儿科ED分诊的疼痛方案对镇痛给药时间(TTA)以及患者和父母满意度的影响。
这是一项前瞻性研究,对3-17岁的患者进行了一项前瞻性研究,这些患者在制定基于分诊的疼痛指南之前和之后出现了小儿ED,该指南允许由分诊护士进行INF管理。我们的主要结局是中位TTA,次要结局包括因疼痛接受INF的患者比例,有不必要的静脉注射,以及患者和父母的满意度。
我们招募了132名患者;72名指南前,60准则后。组间人口统计学相似。组间TTA中位数没有差异(34.5minvs.33分钟,p=.7)。INF的使用率从指南前的41%增加到指南后的60%(p=0.01),不必要的静脉内放置从24%减少到0%(p=0.002)。患者和父母更喜欢IN途径用于镇痛给药。
使用INF的基于分诊的疼痛方案不会降低TTA,但确实导致了INF使用的增加,减少不必要的静脉注射,患者和父母更喜欢静脉注射药物。INF是孤立的四肢受伤儿童的可行镇痛替代方法。
Pain management
guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management
guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction.
This was a prospective study of patients 3-17 years with an isolated orthopedic injury presenting to a pediatric ED before and after instituting a triage-based pain
guideline allowing for administration of INF by triage nurses. Our primary outcome was median TTA and secondary outcomes included the proportion of patients who received INF for pain, had unnecessary IV placement, and patient and parent satisfaction.
We enrolled 132 patients; 72 pre-
guideline, 60 post-
guideline. Demographics were similar between groups. Median TTA was not different between groups (34.5 min vs. 33 min, p = .7). Utilization of INF increased from 41% pre-
guideline to 60% post-
guideline (p = .01) and unnecessary IV placement decreased from 24% to 0% (p = .002). Patients and parents preferred the IN route for analgesia administration.
A triage-based pain protocol utilizing INF did not reduce TTA, but did result in increased INF use, decreased unnecessary IV placement, and was preferred by patients and parents to IV medication. INF is a viable analgesia alternative for children with isolated extremity injuries.