title: Options in prehospital analgesia.
abstract: 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.
authors: Department of Emergency Medicine, Princess Margaret Hospital, Perth Western Australia, Australia. mezzyb@bigpond.com
authors: Meredith L
authors: ML
authors: Borland
authors: Ian
authors: I
authors: Jacobs
authors: Ian R
authors: IR
authors: Rogers
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009609:Nitrous Oxide; D009266:Nalbuphine