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Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison

机译:在紧急情况下管理创伤性疼痛:低剂量甲氧氟烷或一氧化二氮?系统评价和间接治疗比较

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Background: Low-dose methoxyflurane and nitrous oxide (N2O; 50:50 with oxygen) are both self-administered, self-titrated, rapid-acting, nonnarcotic, and noninvasive inhalational agents with similar onset times of pain relief. The aim of this review was to compare the clinical efficacy, safety, and tolerability of these analgesics in emergency care. Materials and methods: A systematic literature search and review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were performed using Embase, Medline, the Cochrane Library, several clinical trial registers, and emergency-medicine conference material. Results: Although both compounds have been used for many years in emergency care, the search found only a few controlled studies and no head-to-head trials performed in this setting. Two double-blind, randomized studies comparing their respective study medication (low-dose methoxyflurane or N2O) to placebo were identified that could be compared in an indirect approach by using placebo as a bridging comparator. Both agents provided rapid pain relief to trauma patients, with no significant differences between them; both treatments were generally well tolerated. Conclusion: Both low-dose methoxyflurane and N2O are suitable options for the pain treatment of trauma patients in the emergency setting. Due to the ease of administration and portability, inhaled low-dose methoxyflurane, however, may not only offer advantages in emergency situations in remote or difficult-to-reach locations and mass-casualty situations but also be of significant value in urban and rural environments.
机译:背景:低剂量甲氧基氟烷和一氧化二氮(N 2 O;含氧气50:50)都是自用,自滴定,速效,非麻醉和无创吸入剂,起效相似减轻疼痛的次数。这篇综述的目的是比较这些镇痛药在急诊中的临床疗效,安全性和耐受性。材料和方法:使用Embase,Medline,Cochrane图书馆,若干临床试验注册簿和急诊医学会议材料,根据系统评价和荟萃分析指南的“首选报告项目”,进行了系统的文献检索和评价。结果:尽管这两种化合物都已用于紧急护理多年,但搜索仅发现了少数对照研究,并且在这种情况下未进行任何头对头试验。确定了两项双盲,随机研究,将其各自的研究药物(低剂量甲氧氟烷或N 2 O)与安慰剂进行了比较,可以通过使用安慰剂作为桥接比较剂以间接方式进行比较。两种药物都能为创伤患者提供快速的疼痛缓解,两者之间无显着差异。两种治疗通常耐受良好。结论:低剂量甲氧基氟烷和N 2 O都是紧急情况下创伤患者疼痛治疗的合适选择。由于易于管理和便携性,吸入低剂量甲氧基氟烷不仅可能在偏远或难以到达的地点的紧急情况下以及大量伤亡情况下具有优势,而且在城乡环境中也具有重要价值。

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