Abstract
BackgroundClinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology.MethodsThe systematic review includes studies from 2000 and up to 2020 that focus on children’s prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results.ResultsThe present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious.ConclusionThe systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.
Highlights
Meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention
Previous studies of children in prehospital care show that the pain was documented in the ambulance records, the level of pain was not assessed in 66–96% of cases [5, 7]
We reviewed an additional 17 full-text studies identified from hand-searched reference lists
Summary
Meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. Prehospital care providers have traditionally focused on time-sensitive acute illness and major traumas, which represent only a small number of patients. Abebe et al Scand J Trauma Resusc Emerg Med (2021) 29:170 the prehospital setting, large groups of patients experience a variety of illnesses and injuries with frequent symptoms and signs, including pain [1]. Previous findings show that 52–88% of children in prehospital setups did not receive pain medication despite having moderate to severe pain [5, 8]. The most common reasons for not providing adequate pain medication to children in prehospital settings include fearing side effects, difficulties with intravenous (IV) line access, being under five years of age, the lack of a pain assessment and the assumption that children need less analgesia than adults [9,10,11,12]
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