Intravenous fentanyl can be given safely to trauma patients for pain in the prehospital setting
Trauma patients can suffer acute pain during prehospital care by paramedics. Intravenous fentanyl, an opioid, is fast-acting and effective at relieving pain in this setting, but it can also cause respiratory depression and low blood pressure. However, a new study found fentanyl was safe and effective at relieving the pain of adults cared for by paramedics. In fact, fentanyl improved the patient's emergency department (ED) shock index (heart rate divided by systolic blood pressure).
The researchers compared 217 trauma patients who received fentanyl with 247 patients who did not receive fentanyl prior to arrival at the hospital. Due to a protocol change, paramedics were able to give a single 100 µg dose of fentanyl without having to call the medical command center. In the fentanyl group, there was a larger proportion of blunt trauma patients, those with a Glasgow Coma Scale of 15 (scores of 3-8 indicates coma), and a higher Injury Severity Score. Patients receiving fentanyl were also more likely to be taken directly to the operating room and less likely to be discharged home. The ED shock index was better for those getting fentanyl compared to those who did not. This advantage continued even after results were adjusted for such things as age, gender, and prehospital shock index. According to the researchers, the findings can be applied to most urban prehospital systems and to the majority of major trauma patients who are not initially hypotensive. The study was supported by the Agency for Healthcare Research and Quality (HS18123 and HS17526).
See "Safety of prehospital intravenous fentanyl for adult trauma patients," by Gina C. Soriya, MD, Kevin E. McVaney, MD, Michael M. Liao, MD, and others in the Journal of Trauma 72(3), pp. 755-759, 2012.
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