目的:自从RAVE-2抗蛇毒血清疗效研究结果公布后,Redback蜘蛛(RBS)抗蛇毒血清(RBSAV)的使用似乎有所减少。这项研究的目的是评估RBSAV使用随时间的变化,并比较抗蛇毒血清和其他镇痛药的治疗反应。
方法:将RBS咬伤转介给毒理学部门的回顾性审核,2010年1月至2022年1月。数据包括人口统计,疼痛严重程度,治疗(镇痛或RBSAV),对治疗的反应,重新列报率,不良事件,随着时间的推移,抗蛇毒血清的使用发生变化。
结果:在270个演示文稿中,纳入157例中度或重度疼痛(RBSAVn=51,镇痛n=106)。年龄中位数是39岁,n=81(51%)女性。接受抗蛇毒血清的患者更有可能报告严重疼痛,n=46/51(84%),n=68/106(58%)(P=0.006)。在2010年至2013年之间使用了83%的抗蛇毒血清剂量。仅镇痛组接受扑热息痛的各种组合,NSAIDs,和阿片类药物。在那些接受RBSAV的人中,17/48(35%),26/48(54%),5/48(10%)报告部分,疼痛完全或没有减轻,分别,与30/77(39%)相比,43/77(58%)和4/77(5%),仅用于镇痛组。在3名RBSAV和28名仅镇痛患者中未记录治疗后疼痛。静脉和肌肉内抗蛇毒血清的疼痛减轻没有差异。持续疼痛的重新表现在单纯镇痛组中更为常见,抗血清16/106(15%)对1/51(2%)(P=0.013)。
结论:抗蛇毒血清的使用在研究期间有所下降。RBSAV组和单纯镇痛组之间的疼痛缓解没有差异。RBSAV,不管给药途径如何,在本研究中,在减轻疼痛方面并不比标准镇痛药好。
Redback spider (RBS) antivenom (RBSAV) use appears to have decreased since the results of the RAVE-2 antivenom efficacy study were released. The aims of this study were to assess change in RBSAV use over time and compare responses to treatment for antivenom and other analgesics.
Retrospective audit of RBS bite referrals to a toxicology unit, from January 2010 to January 2022. Data included demographics, pain severity, treatment (analgesia or RBSAV), response to treatment, re-presentation rate, adverse events, change in antivenom use over time.
Of 270 presentations, 157 with moderate or severe pain were included (RBSAV n = 51, analgesia n = 106). Median age was 39 years, n = 81 (51%) female. Those receiving antivenom were more likely to report severe pain n = 46/51 (84%) versus n = 68/106 (58%) (P = 0.006). Eighty-three percent of antivenom doses were administered between 2010 and 2013. Analgesia-only group received various combinations of paracetamol, NSAIDs, and opioids. In those receiving RBSAV, 17/48 (35%), 26/48 (54%), 5/48 (10%) reported a partial, complete or no reduction in pain, respectively, versus 30/77 (39%), 43/77 (58%) and 4/77 (5%), for analgesia-only group. Post-treatment pain was not recorded in three RBSAV and 28 analgesia-only patients. Pain reduction was no different for intravenous and intramuscular antivenom. Re-presentation for ongoing pain was more common in the analgesia-only group, 16/106 (15%) versus 1/51 (2%) for antivenom (P = 0.013).
Antivenom use fell over the study period. There was no difference in pain relief between RBSAV and analgesia-only groups. RBSAV, regardless of route of administration, was no better than standard analgesics in pain reduction in the present study.