Universität zu Köln

Haeske, David, Boettiger, Bernd W., Bouillon, Bertil, Fischer, Matthias, Gaier, Gernot, Gliwitzky, Bernhard, Helm, Matthias, Hilbert-Carius, Peter, Hossfeld, Bjoern, Meisner, Christoph, Schempf, Benjamin, Wafaisade, Arasch and Bernhard, Michael (2017). Analgesia in Patients with Trauma in Emergency Medicine A Systematic Review and Meta-analysis. Dtsch. Arztebl. Int., 114 (46). S. 785 - 799. COLOGNE: DEUTSCHER AERZTE-VERLAG GMBH. ISSN 1866-0452

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Abstract

Background: Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. Methods: This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. Results: Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. Conclusion: Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Haeske, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Boettiger, Bernd W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Gaier, Gernot UNSPECIFIED UNSPECIFIED UNSPECIFIED Gliwitzky, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Helm, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Hilbert-Carius, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hossfeld, Bjoern UNSPECIFIED UNSPECIFIED UNSPECIFIED Meisner, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Schempf, Benjamin UNSPECIFIED UNSPECIFIED UNSPECIFIED Wafaisade, Arasch UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernhard, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-211155
DOI:	10.3238/arztebl.2017.0785
Journal or Publication Title:	Dtsch. Arztebl. Int.
Volume:	114
Number:	46
Page Range:	S. 785 - 799
Date:	2017
Publisher:	DEUTSCHER AERZTE-VERLAG GMBH
Place of Publication:	COLOGNE
ISSN:	1866-0452
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RANDOMIZED CONTROLLED-TRIAL; SEVERELY INJURED PATIENTS; ACUTE PAIN; PREHOSPITAL ANALGESIA; INTRAVENOUS MORPHINE; PROCEDURAL SEDATION; INTRANASAL FENTANYL; DOUBLE-BLIND; ADVERSE EVENTS; DOSE KETAMINE Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21115