Effects on patient care of introducing prehospital intravenous nalbuphine hydrochloride

Since March 1992, intravenous nalbuphine hydrochloride has been used prehospital by paramedics in the Plymouth area. This study assesses the impact of this intervention.

A prospective study of the parenteral analgesic requirements of 1000 consecutive patients arriving by ambulance at the accident and emergency (A&E) department of a large district general hospital. Where parenteral analgesia was given in the A&E department but not by ambulance personnel, a questionnaire was sent to the ambulance crew concerned to ascertain the reasons for not having given nalbuphine.

Of 1000 consecutive patients arriving by ambulance, 87 (8.7%) had been given parenteral analgesia either prehospital, in A&E, or in both places. Seventy five (7.5%) needed parenteral analgesia in the A&E department, 29 (2.9%) had been given prehospital intravenous analgesia by paramedics, and a further seven (0.7%) had been given parenteral analgesia by a general practitioner (GP). Thus 36 (3.6%) received prehospital analgesia. Ten patients who had been given analgesia by paramedics required no further analgesia in A&E, whereas 51 patients who had not been given prehospital analgesia required parenteral analgesia in the A&E department.

The introduction of nalbuphine for use by paramedics in prehospital care has increased prehospital parenteral analgesia from 1% in 1992 (given by GPs only) to 3.6% in the current study group, and 41% of patients requiring parenteral analgesia received analgesia prehospital. There may be further scope for extending the indications for nalbuphine use by ambulance personnel.