ABSTRACT
OBJECTIVE: Following recent changes to the German Narcotics Act, this article examines prehospital analgesia by paramedics using piritramide vs. nalbuphineâ¯+ paracetamol. MATERIAL AND METHODS: Prehospital analgesia administered by paramedics from the Fulda (piritramide) and Gütersloh (nalbuphineâ¯+ paracetamol) emergency services was compared regarding pain intensity at the beginning and end of the mission, measured using the numeric rating scale (NRS). Additionally, an analysis of the resulting complications was carried out. RESULTS: In this study 2429 administrations of analgesia were evaluated (nalbuphineâ¯+ paracetamol: 1635, 67.3%, initial NRS: 8.0⯱ 1.4, end of NRS: 3.7⯱ 2.0; piritramide: 794, 32.7%, initial NRS: 8.5⯱ 1.1, end of NRS: 4.5⯱ 1.6). Factors influencing NRS change were initial NRS (regression coefficient, RC: 0.7075, 95% confidence interval, CI: 0.6503-0.7647, pâ¯< 0.001), treatment with nalbuphineâ¯+ paracetamol (RC: 0.6048, 95% CI: 0.4396-0.7700, pâ¯< 0.001). Treatment with nalbuphineâ¯+ paracetamol (nâ¯= 796 (48.7%)) compared to piritramide (nâ¯= 190 (23.9%)) increased the odds of achieving NRSâ¯< 4 (odds ratio, OR: 2.712, 95% CI: 2.227-3.303, pâ¯< 0.001). Complications occurred in nâ¯= 44 (5.5%) with piritramide and in nâ¯= 35 (2.1%) with nalbuphineâ¯+ paracetamol. Risk factors for complications were analgesia with piritramide (OR: 2.699, 95% CI: 1.693-4.301, pâ¯< 0.001), female sex (OR: 2.372, 95% CI: 1.396-4.029, pâ¯= 0.0014), and age (OR: 1.013, 95% CI: 1.002-1.025, pâ¯= 0.0232). CONCLUSION: Compared with piritramide, prehospital analgesia with nalbuphineâ¯+ paracetamol has favorable effects in terms of analgesic efficacy and complication rates and should therefore be considered in future recommendations for paramedics.
Subject(s)
Acetaminophen , Emergency Medical Services , Nalbuphine , Pirinitramide , Nalbuphine/administration & dosage , Nalbuphine/therapeutic use , Nalbuphine/adverse effects , Humans , Acetaminophen/therapeutic use , Acetaminophen/administration & dosage , Acetaminophen/adverse effects , Female , Male , Middle Aged , Adult , Pirinitramide/administration & dosage , Pirinitramide/therapeutic use , Aged , Allied Health Personnel , Pain Measurement , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Analgesia/methods , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/therapeutic use , Analgesics, Non-Narcotic/adverse effects , Young Adult , Adolescent , ParamedicsABSTRACT
BACKGROUND: Despite the development of various analgesic concepts, prehospital oligoanalgesia remains very common. The present work examines prehospital analgesia by paramedics using morphine vs. nalbuphine + paracetamol. METHODS: Patients with out-of-hospital-analgesia performed by paramedics from the emergency medical services of the districts of Fulda (morphine) and Gütersloh (nalbuphine + paracetamol) were evaluated with regards to pain intensity at the beginning and the end of prehospital treatment using the Numeric-Rating-Scale for pain (NRS), sex, age, and complications. The primary endpoint was achievement of adequate analgesia, defined as NRS < 4 at hospital handover, depending on the analgesics administered (nalbuphine + paracetamol vs. morphine). Pain intensity before and after receiving analgesia using the NRS, sex, age and complications were also monitored. RESULTS: A total of 1,808 patients who received out-of-hospital-analgesia were evaluated (nalbuphine + paracetamol: 1,635 (90.4%), NRS-initial: 8.0 ± 1.4, NRS-at-handover: 3.7 ± 2.0; morphine: 173(9.6%), NRS-initial: 8.5 ± 1.1, NRS-at-handover: 5.1 ± 2.0). Factors influencing the difference in NRS were: initial pain intensity on the NRS (regression coefficient (RK): 0.7276, 95%CI: 0.6602-0.7950, p < 0.001), therapy with morphine vs. nalbuphine + paracetamol (RK: -1.2594, 95%CI: -1.5770 - -0.9418, p < 0.001) and traumatic vs. non-traumatic causes of pain (RK: -0.2952, 95%CI: -0.4879 - -0.1024, p = 0.002). Therapy with morphine (n = 34 (19.6%)) compared to nalbuphine + paracetamol (n = 796 (48.7%)) (odds ratio (OR): 0.274, 95%CI: 0.185-0.405, p < 0.001) and the initial NRS score (OR:0.827, 95%CI: 0.771-0.887, p < 0.001) reduced the odds of having an NRS < 4 at hospital handover. Complications occurred with morphine in n = 10 (5.8%) and with nalbuphine + paracetamol in n = 35 (2.1%) cases. Risk factors for complications were analgesia with morphine (OR: 2.690, 95%CI: 1.287-5.621, p = 0.008), female sex (OR: 2.024, 95%CI: 1.040-3.937, p = 0.0379), as well as age (OR: 1.018, 95%CI: 1.003-1.034, p = 0.02). CONCLUSIONS: Compared to morphine, prehospital analgesia with nalbuphine + paracetamol yields favourable effects in terms of analgesic effectiveness and a lower rate of complications and should therefore be considered in future recommendations for prehospital analgesia.