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Evidence-Based Guidelines for Prehospital Pain Management: Recommendations
George Lindbeck1, Manish I Shah2, Sabina Braithwaite3
1Office of Emergency Medical Services, Virginia Department of Health, and the Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Prehospital Emergency Care
|December 20, 2021
Summary
Emergency Medical Services (EMS) clinicians have diverse analgesic options beyond opioids for moderate to severe pain. Guidelines recommend intranasal fentanyl for pediatric patients and conditionally support various intravenous and oral non-opioid analgesics.
Area of Science:
- Emergency Medicine
- Pharmacology
- Evidence-Based Practice
Background:
- Moderate to severe pain management in prehospital settings presents challenges for Emergency Medical Services (EMS) clinicians.
- A systematic review identified comparative effectiveness of analgesics in prehospital care, forming the basis for guideline development.
- Existing guidelines may not fully encompass the range of effective analgesic options available.
Purpose of the Study:
- To develop evidence-based guidelines for analgesic administration by EMS clinicians for moderate to severe pain.
- To provide recommendations based on a systematic review of analgesic effectiveness in the prehospital setting.
- To offer a broader range of analgesic options beyond opioids for acute pain management.
Main Methods:
- A technical expert panel (TEP) comprising prehospital care and guideline development specialists was convened.
- Patient/Population/Intervention/Comparison/Outcome (PICO) questions were formulated based on a systematic review and pediatric considerations.
- Recommendations were developed through expert consensus informed by the systematic review data.
Main Results:
- Strong recommendation for intranasal fentanyl over intravenous (IV) opioids for pediatric patients lacking IV access.
- Conditional recommendations for IV non-steroidal anti-inflammatory drugs (NSAIDs) over IV acetaminophen (APAP), and various IV opioid or ketamine combinations.
- Conditional recommendations for oral APAP or NSAIDs when oral administration is preferred, and against specific IV ketamine/opioid combinations.
Conclusions:
- EMS clinicians have multiple effective analgesic options for moderate to severe pain, including non-opioid alternatives.
- Guidelines support the use of intranasal fentanyl for pediatric pain and offer conditional guidance on various IV and oral analgesics.
- The recommendations aim to broaden pain management strategies for EMS, reducing sole reliance on opioids.
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