Contributors: 1Research Department, Prehospital Emergency Medical Service, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus, Denmark. k.friesgaard@me.com. 2Department of Anaesthesiology, Regional Hospital of Horsens, Horsens, Denmark. k.friesgaard@me.com. 3Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark. k.friesgaard@me.com. 4Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway. 5Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 6Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. 7Trauma Unit, Sørlandet Hospital, Kristiansand, Norway. 8Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland. 9Anaesthesia Research Group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland. 10Centre for Prehospital Emergency Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. 11Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden. 12Department of Prehospital Care and Disaster Medicine, Region of Skåne, Lund, Sweden. 13Landspitalinn University Hospital, Reykjavik, Iceland. 14Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway. 15Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark. 16Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 17Danish Air Ambulance, Aarhus, Denmark.
Abstract: To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download ; Introduction: Acute pain is a frequent symptom among patients in the pre-hospital setting, and opioids are the most widely used class of drugs for the relief of pain in these patients. However, the evidence base for opioid use in this setting appears to be weak. The aim of this systematic review was to explore the efficacy and safety of opioid analgesics in the pre-hospital setting and to assess potential alternative therapies. Methods: The PubMed, EMBASE, Cochrane Library, Centre for Reviews and Dissemination, Scopus, and Epistemonikos databases were searched for studies investigating adult patients with acute pain prior to their arrival at hospital. Outcomes on efficacy and safety were assessed. Risk of bias for each included study was assessed according to the Cochrane approach, and confidence in the evidence was assessed using the GRADE method. Results: A total of 3453 papers were screened, of which the full text of 125 was assessed. Twelve studies were ultimately included in this systematic review. Meta-analysis was not undertaken due to substantial clinical heterogeneity among the included studies. Several studies had high risk of bias resulting in low or very low quality of evidence for most of the outcomes. No pre-hospital studies compared opioids with placebo, and no studies assessed the risk of opioid administration for subgroups of frail patients. The competency level of the attending healthcare provider did not seem to affect the efficacy or safety of opioids in two observational studies of very low quality. Intranasal opioids had a similar effect and safety profile as intravenous opioids. Moderate quality evidence supported a similar efficacy and safety of synthetic opioid compared to morphine. Conclusions: Available evidence for pre-hospital opioid administration to relieve acute pain is scarce and the overall quality of ...
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