Options in prehospital analgesia.
BACKGROUND
Prehospital analgesia options for paramedics have been limited due to the difficulty in achieving safe and effective pain relief without compromising transportation to hospital. The present paper identifies the analgesia methods currently available in the prehospital setting so as to evaluate the various options and highlight areas for future research.


METHODS
A literature review of Medline and Embase databases from 1966 until the present was undertaken. Further hand searching of all the references identified in these papers was also performed. All current literature was analysed and categorized according to one of four levels of evidence using National Health and Medical Research Council of Australia guidelines (1999).


RESULTS
There is a paucity of randomized control trials relating to prehospital analgesia. All published literature was level III or IV prospective or retrospective studies. Drug options used included nitrous oxide/oxygen mixtures, intravenous/intramuscular nalbuphine, intravenous tramadol and intravenous pure opiate agonists.


CONCLUSIONS
The evidence supporting analgesic options in the prehospital setting is limited. There are few published data in this area despite the inadequacy of pain relief being recognized as a weakness in prehospital care. Prehospital analgesia is an area worthy of innovative methods for the administration of safe and effective analgesics without significant impact on transport times. Such methods should be prospectively evaluated in well-constructed trials.
Borland
Meredith L
ML
Department of Emergency Medicine, Princess Margaret Hospital, Perth Western Australia, Australia. mezzyb@bigpond.com
Jacobs
Ian
I
Rogers
Ian R
IR
D000698:Analgesia / Q000592:standards* / Q000639:trends; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009266:Nalbuphine / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D012042:Registries; D012680:Sensitivity and Specificity; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome; D014904:Western Australia
D000701:Analgesics, Opioid; D014147:Tramadol; D009609:Nitrous Oxide; D009266:Nalbuphine