Procedural Sedation and Analgesia in Trauma Patients in an Out-of-Hospital Emergency Setting: A Prospective Multicenter Observational Study.

Details

Serval ID
serval:BIB_374AEDBBC311
Type
Article: article from journal or magazin.
Collection
Publications
Title
Procedural Sedation and Analgesia in Trauma Patients in an Out-of-Hospital Emergency Setting: A Prospective Multicenter Observational Study.
Journal
Prehospital emergency care
Author(s)
Galinski M., Hoffman L., Bregeaud D., Kamboua M., Ageron F.X., Rouanet C., Hubert J.C., Istria J., Ruscev M., Tazarourte K., Pevirieri F., Lapostolle F., Adnet F.
ISSN
1545-0066 (Electronic)
ISSN-L
1090-3127
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
22
Number
4
Pages
497-505
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The quality of procedural analgesia and sedation among trauma patients has not been studied much in the prehospital setting. The main objective of this study was to characterize the quality of procedural analgesia sedation practices in prehospital settings in trauma patients.
This was an open-label observational prospective multicenter study (January 01, 2012-December 31, 2013). We included all consecutive trauma victims undergoing a potentially painful procedure on the accident scene. The primary endpoint was the procedural pain intensity.
Data for 210 patients aged 11 to 98 years were analyzed. The most common lesions were limb fractures or dislocations. The most common procedures were limb realignment and splinting. Overall, 25 different drug combinations [with paracetamol [acetaminophen], non-steroidal anti-inflammatory drugs, nefopam, opioids, loco-regional anesthesia, Equimolar Mixture of Oxygen/Nitrous Oxide (EMONO), sedative drugs] were used by the emergency medical services (EMS). One hundred seventeen patients (55%) received either one or two sedative drugs (among ketamine, propofol, and midazolam), 171 patients (81%) received morphine that was combined with a sedative drug in 54% of cases. During the procedure, 95 patients, 45% [95% Confidence Interval (CI) 39-52] experienced intense to severe pain. Among patients who received sedative drugs, 27% (32/117) had intense to severe pain vs. 68% (63/93) in patients who did not, that is, 40% difference [95% CI 33.8-47.0]. Seventeen patients (8%) experienced 18 adverse events of which 6 were respiratory adverse events. A deep sedation occurred in 17 patients. No center had any specific protocols for procedural sedation analgesia.
Procedural sedation-analgesia was inadequate in almost half of the trauma patients in the out-of-hospital setting. The reasons of these failures were probably multiple. The non-administration of a sedative drug despite an indication or non-adapted doses, in the context of a lack of specific protocols, was certainly one of them.
Keywords
acute pain, procedural sedation and analgesia, trauma
Pubmed
Web of science
Create date
11/02/2019 14:35
Last modification date
20/08/2019 13:25
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