Pain Management In Emergency Department Research Articles

Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department.

Study Objective: Pain management in emergency department (ED) patients is challenging. Although both pharmacological and nonpharmacological therapies exist, they are often suboptimal. Immersive virtual reality (VR) uses distraction and possible other methods to reduce perceptions of pain. The purpose of the study is to evaluate the usability and acceptability of VR applications in ED patients by assessing patient-reported changes in pain, anger, and anxiety levels.Methods:This is a prospective cohort study at a single academic urban tertiary care center among ED patients with a pain score ≥3 on a numeric rating scale (0-10 integers) for any reason. Patients with stroke, epilepsy, dementia, or other diseases that may prevent use of VR were excluded. Enrolled patients in the intervention cohort spent 20 min using VR applications. A paired t test was used to analyze the change of pain, anger, and anxiety scores between pre- and postintervention. Analysis of variance and linear regression were used to assess the impact of other subject variables (including gender, age, race, and education) on pre-post intervention changes.Results:One hundred (N = 100) patients were enrolled in this study and 93 experienced the VR intervention. Of these, 57 (61.3%) were women, and mean age was 38 ± 14. Mean anger (2.28 ± 0.8 to 1.92 ± 0.7, p < 0.0001), anxiety (2.06 ± 0.8 to 1.81 ± 0.8, p < 0.0001), and pain (7.16 ± 2.5 to 6.49 ± 2.7, p < 0.0001) levels dropped significantly from pre- to postintervention. Outcomes of the VR intervention were impacted by subject variables, including education and ethnicity. Pain (1.86 ± 3.3, p = 0.03) and anger (1.03 ± 1.4, p = 0.02) levels dropped most for those with less than high school education. Linear regression analysis revealed that patients with higher levels of health/quality of life (QOL) had larger mean drop per unit predictor for anger (0.29 [0.09], p = 0.0013) and anxiety (0.22 [0.07], p = 0.001).Conclusions: VR applications are feasible for ED patients and may lead to reduced pain, anger, and anxiety levels. These outcomes are affected by subject ethnicity, educational status, and health/QOL although independent of the chief complaint.

A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol.

AimsPain is underestimated and insufficiently treated in Emergency Departments (ED). The primary objective of this multicenter, prospective, observational, and interventional study is to analyze the clinical impact of a simulation-based training for Emergency Nurses on pain assessment and management. Secondary objectives are to measure instructed staff's satisfaction with the simulation training and to evaluate the progress of participants as well as studying the clinical impact of this course: level of correlation between accuracy of analgesia and level of pain, assessment of patient and caregiver satisfaction.Designthis study will be undertaken in EDs at two university hospitals (Paris, France: Bichat and Beaujon) with randomly selected experimental and control groups.MethodsDuring the first phase, inventories in the EDs of current professional practice will be realized. Then, the control group will have theoretical classes and the experimental group will have both the theoretical class and simulation courses for all the nurses (with simulated patients in trauma pain scenarios). Post course assessment will be established of triage nurses' and other nurses’ practice changes concerning trauma pain management in EDs. Moreover, this study will include an assessment of the impact on patient and caregiver satisfaction. All patients over 18 years old who are admitted to the ED for a non-vital trauma are included. Exclusion criteria are patients who are admitted by an EMS ambulance.Clinical implicationthis study seeks to demonstrate that the implementation of a theoretical course combined with a simulation session will improve pain management in EDs by Emergency Nurses.

Medico-economic study of pain in an emergency department: a targeted literature review

ABSTRACTBackground: Pain management in emergency departments is a complex objective. The absence of a care pathway or a high level of activity complicates diagnostic or analgesic therapeutic strategies. Medical innovation can impact both individual practices and the functioning of an emergency department.Objective: We then wanted to understand how medico-economic studies on pain were carried out in an emergency department.Study design: We reviewed the literature of the last 20 years (between 1998 and 2018).Setting: Of 846 titles screened, a total of 268 abstracts qualified for further screening, and 578 titles were excluded. A total of 14 studies qualified for inclusion in the review. Studies on medico-economics in an emergency department are very diverse. None of the methods used are identical; the studies differ in their very nature (prospective, retrospective, cost-effectiveness, etc.) and the determination of emergency room costs differs according to the part of the world studied. In addition, organizational impact is rarely measured, although it is an essential dimension for choosing or not a medical innovation.

Barriers and Enablers to Pain Management in Emergency Department

This paper is just a sample template for the prospective authors of IISTE Over the decades, Background: Despite the growing interest in pain management (PM) around the world, under treatment of pain is still a major problem faced by the healthcare professionals in emergency departments (EDs). Identifying barriers and enablers of PM among nurses and physicians is important to overcome factors that hinder effective PM. Aim: To explore the barriers and enablers of PM among nurses and physicians working in the Jordanian EDs. Design: Descriptive cross-sectional design, using self-reported questionnaire. Result: Nursing participants reported moderate mean score of barriers (M6.68), while physicians reported (6.65). On the hand, nurses’ participants reported a mean of enablers (6.68), while physicians reported (6.65).There was no significant difference in the barriers and enablers of PM between nurses and physicians. However, among all enablers of PM, "following a protocol for pain assessment" and "treating pain as the fifth vital sign" contribute to optimal PM care?" differed between nurses and physicians. The least frequently reported barrier of PM for nurses and physicians was "Lack of intravenous access", which was reported by 66 nurses (39.1%) and 25 physicians (35.2%). The least frequently reported enabler of PM for both physicians and nurses was "Do you have a PM Champion in your area?" No significant correlation between the demographic characteristics of nurses and physicians and the total scores of enablers and barriers of PM was found. Conclusion: There is a need to adopt an intervention to overcome barriers of PM by training sessions and monitor side effects of medication, as well as enhance the enablers of PM by using of posters and focus on pain policies and protocols. Keywords: Pain Management; Enablers; Barriers; Nurses; Physicians; Emergency Departments. DOI : 10.7176/JHMN/58-06

Children's satisfaction and dissatisfaction with pain management in a Pediatric Emergency Department.

To understand children's satisfaction and dissatisfaction with pain management in the pediatric emergency department. Exploratory-descriptive qualitative study performed with children between 6 and 12 years of age and use of semi-structured interviews and thematic analysis of data. Nineteen children were interviewed. The results were organized in two themes: Theme 1 - Satisfaction perceived by children regarding pain management, which included three subthemes, namely: Priority care and quick pain relief, Basic needs met and Embracement by the team; and Theme 2 - Dissatisfaction perceived by children regarding pain management, which included three subthemes: Painful procedures, Uncomfortable environment and Delay in pain relief. Children's satisfaction with pain management was observed to be much more than pain relief or priority service, and also included the pediatric emergency department environment and embracement by the team. Care should be directed to children's singularities, that is, a care built from the understanding of the experience from children's point of view.

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study.

Background Adequate pain management has led to increased comfort in emergency patients, reducing morbidity and improving long term outcomes. Different pain management modalities have been applied in the emergency department among which systemic analgesia is commonly used by preceding a nerve block. Several factors have been associated with poor pain management in low resource setting areas. We aimed to determine pain management modalities and associated factors among emergency surgical patients. Patients and Methods After obtaining ethical approval from Ethical Review Committee, 203 volunteer patients were enrolled. Institutional based cross-sectional prospective study was conducted from April to May 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured through Numerical Rating Scale and statistical analysis was performed using SPSS statistical package version 23. Descriptive statistics cross-tab and binary logistics were performed to identify factors related to pain management in emergency department. Results A total of 203 patients, 138 (68%) males and 65 (32%) females with response rate of 94%, participated in this study. Among them, 66% patients received analgesia within two hours of ED presentation with a mean ± SD of 61.0 ± 34.1 minutes. 70.4 % of patients complained of moderate and severe pain after receiving analgesia. There was a significant difference between trauma and nontrauma patients in mean time of analgesia receiving and residual pain severity (p < 0.001). Age, trauma, physician pain assessment, and severity of pain were the predicting factors for analgesia delivery. Conclusion The overall practice of pain management in Gondar University Specialized Hospital Emergency Department was not adequate. Therefore, it is vital to implement an objective pain assessment method and documentation of the pain severity to improve pain management practice.

MP42: Validation of the Stoplight Pain Scale tool in the Canadian emergency setting

Introduction: Introduction: A variety of pain assessment tools exist for children, however none of the current scales were created specifically for family use. Further, none provide direct guidance with regards to pain treatment threshold. This study aimed to validate a novel, three faced, coloured coded (red, yellow, green), family-friendly pain tool, the Stoplight Pain Scale, by comparing it to the widely accepted and validated Faces Pain Scale-Revised (FPS-R). This novel tool has the capability to guide families with regards to treatment, as well as measure pain. Methods: Methods: A prospective observational cohort study was conducted at the Stollery Childrens Hospital emergency department (ED) (Edmonton, Alberta) from November, 2014 to February, 2017. Demographic information was collected, and patients (3-12 years) and their caregivers were asked to rate their pain using the novel Stoplight Pain Scale as well as the FPS-R. Pain was measured at presentation to the ED, immediately following painful procedures, and thirty minutes after analgesia administration. Patients and their caregivers also indicated their preferred scale for assessing pain. Results: Results: A purposeful random sample of 227 patients were included for analyses; 61/227 (26.9%) of patients were 3-5 years old and 166/227 (73.1%)were 6-12 years old. 53/227 (23.3%) of patients had been previously hospitalized. Correlation between the two pain scales was consistently fair to moderate; using Kappa Statistics, a baseline correlation for Stoplight and FPS-R was fair for both caregivers (0.38, 95% CI 0.28 0.48) and patients (0.36 95% CI 0.27-0.45). The Stoplight Pain Scale had fair to moderate correlation between caregiver and patient scores, (0.37, 95% CI 0.27-0.47), compared to FPS-R which showed poor to fair agreement between caregiver and child scores (0.20, 95% CI 0.12-0.29). Regardless of age or hospitalization status, 64% of patients (139/218) and 54% caregivers (118/220) preferred the Stoplight Pain scale (p=0.001). Conclusion: Conclusions: The Stoplight Pain Scale correlates moderately well with FPS-R, a validated pain assessment tool for children and shows good correlation between patients and caregivers assessment of reported pain. The Stoplight Pain Scale is a simple, easy to administer tool that may have a role in empowering family involvement in ED pain management. Future research should focus on at-home study of the tool.

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis.

Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain. We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses. Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain. Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.

Designing and Implementing Emergency Department Pain Management Curriculum: A Delphi Approach.

Our primary objective was to use the Delphi method (DM) to choose learning objectives for an Internet-based pain management teaching module for emergency care providers. The DM is a structured communication technique that uses systematic, interactive data gathering to reach a consensus among a panel of experts. We extracted preliminary educational objectives from nationwide pain fellowship training programs. After redundant objectives and those relating to procedures outside the scope of emergency medicine (EM) were removed, 23 preliminary objectives remained. We enlisted experts in EM, medical toxicology, anesthesia, pain, psychiatry, and medical education to evaluate the objectives in repeated rounds. Based on the time we had designated for teaching (3 hours) and our estimate of 15 to 20 minutes for each learning objective, we aimed for nine to 12 final learning objectives. The expert panel rated the 23 preliminary objectives with a 5-point Likert scale. Experts were blinded to each other's answers. When 80% of experts agreed with proposed objectives, objectives were considered "accepted" and retained. When 80% of experts disagreed with proposed objectives, the objectives were considered "rejected" and discarded. The remaining objectives were considered in subsequent rounds. In the first round, one objective was rejected and four were accepted. In the second round, four objectives were rejected and five were accepted. Having reached nine objectives the panel unanimously agreed that the nine objectives were sufficient to be used as a foundation for teaching modules. Using the DM, our expert panel identified nine educational objectives that were used as the foundation for an educational module. Of the nine objectives, three were categorized as "medical knowledge," two as "pharmacologic knowledge," two as "patient communication," and two as "systems-based practice." The learning objectives are as follows: recognize common barriers to treating pain; understand alternative interventional therapies used to treat different kinds of pain their implications, benefits, and risks; identify common component symptoms that may exacerbate chronic pain (i.e., depression, anxiety, delirium, cachexia, dyspnea); study the major drug groups used to treat different kinds of pain; recognize the risks of polypharmacy; set realistic expectations with patients early in their presentation to the emergency department (ED); educate patients as the risks of different classes of pain medications, including risk of addiction; understand the legal and regulatory issues that govern pain management in the ED; and understand in-hospital resources available for patient follow up and referral to pain clinics. We successfully used the DM to develop educational objectives for an e-learning module. Further work should evaluate educational outcomes of the teaching module.

Key Performance Indicators of Chest Pain Management in Emergency Department; a Letter to the Editor.

Chest pain is a common complaint among those presenting to emergency department (ED) and is associated with a high rate of mortality. Based on National Center for Health Statistics, chest pain leads to about 6 million visits to EDs in United State. In Iran, ischemic cardiac diseases are the second cause of death in people aged 15 to 49 years. While less than 10% of the patients presenting to ED with chest pain are affected with myocardial infarction (MI), 33% of MI cases are silent. Timely diagnosis and revascularization of ischemic part, using thrombolytic agents or percutaneous coronary intervention (PCI), can save cardiac function and the patient’s life. Therefore, in this regard the emphasis is on rapid referral of the patients to treatment centers, initiation of diagnostic measures such as electrocardiography (ECG) and in case of meeting the required criteria, transfer to cat lab for PCI. American Heart Association (AHA) has introduced the proper door to ECG time as 10 minutes if it has not been done in the ambulance. Based on this recommendation, AHA has defined the aims of coronary reperfusion as prescription of thrombolytic in the initial 30 minutes after admission of the patient to ED or PCI in the initial 90 minutes after admission to ED.

The effect of pain management in reducing limb and spine radiography in stable traumatic patients admitted to the emergency department

Introduction Musculoskeletal pain caused by trauma is one of the common complaints of patients referred to the emergency department. Due to the lack of a proper pain control protocol, doctors and nurses do not pay attention to pain, and physicians may tend to request too many radiographs, many of which will be unnecessary. We aimed to study the effect of pain management by fentanyl in reducing the number of radiographs, reducing hospital costs and increasing satisfaction in the patients on patients with isolated trauma in limbs and spine causing musculoskeletal pain. Patients and methods A cohort of patients who were referred to the fast-track emergency department with isolated trauma of the upper and lower limbs or spine and triage levels 3, 4 and 5, were visited twice by an emergency medicine resident – before and after application of a pain management protocol using intravenous fentanyl as the principle analgesic. The primary outcome measure was the reduction in the number of radiographs requested; secondary outcomes included alterations in pain levels and patient satisfaction. Results A total of 158 patients were included in the study. The median age was 27.5 years, three quarters were male and 20.88% had a positive history of opium addiction. The number and costs of diagnostic radiography significantly decreased after the administration of fentanyl (P &lt; 0.0001), as did pain levels measured on visual analogue scale with a consequent increase in patient satisfaction. There were only six complications resulting from fentanyl administration which were mild and transient. Follow-up after 24–72 h, revealed no missed fractures. Conclusions The administration of fentanyl as a strong analgesic as part of an emergency department pain management protocol for trauma patients can be performed with limited minor complications; it can reduce the number of unnecessary X-rays performed, exposure to ionizing radiation and hospital costs as well as improving patient satisfaction without missing fractures.

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge.

An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.

The PIPER WEEKEND study. Children's and adults satisfaction regarding paediatric pain in Italian Emergency Department.

Despite pain being a crucial aspect of urgent-emergency care, the attention of healthcare workers towards this symptom in the Emergency Department (ED) is still inadequate. The aims of this study were to assess children's and their adults accompanier's satisfaction regarding pain management in Italian ED, considering healthcare workers' attention to the symptom as well as the appropriateness and efficacy of treatments received. Questionnaires were administered face-to-face by trained interviewers over the period of one weekend in 29 Italian ED. The questionnaires were addressed to children 3-16 years old, assigned a green code at triage, and their adult accompaniers. Overall, 1581 questionnaires were administered (923 to parents or caregivers, 658 to children). The reported level of attention to pain by the care team was high (57.20%) as was the adults' satisfaction with the pain management (95.01%); a high level of satisfaction was related to the healthcare workers' attention to pain. According to the adults, 73.56% of the healthcare professionals collected accurate information about pain; this was confirmed by the children. Pain was managed by a doctor-and-nurse team in less than half the cases (43.77%). Therapy efficacy was reportedly poor: only 14.01% of children were pain-free when leaving the ED. Despite increasing understanding of pain and the availability of guidelines and effective analgesics, efficient pain relief in paediatric patients in the ED remains an unfulfilled goal: half of children with pain did not receive any treatments. Therefore the quality of pain management in the ED needs to be improved.

Pediatric emergency department triage-based pain guideline utilizing intranasal fentanyl: Effect of implementation

BackgroundPain management guidelines in the emergency department (ED) may reduce time to analgesia administration (TTA). Intranasal fentanyl (INF) is a safe and effective alternative to intravenous opiates. The effect of an ED pain management guideline providing standing orders for nurse-initiated administration of intranasal fentanyl (INF) is not known. The objective of this study was to determine the impact of a pediatric ED triage-based pain protocol utilizing intranasal fentanyl (INF) on time to analgesia administration (TTA) and patient and parent satisfaction. MethodsThis was a prospective study of patients 3–17 years with an isolated orthopedic injury presenting to a pediatric ED before and after instituting a triage-based pain guideline allowing for administration of INF by triage nurses. Our primary outcome was median TTA and secondary outcomes included the proportion of patients who received INF for pain, had unnecessary IV placement, and patient and parent satisfaction. ResultsWe enrolled 132 patients; 72 pre-guideline, 60 post-guideline. Demographics were similar between groups. Median TTA was not different between groups (34.5 min vs. 33 min, p = .7). Utilization of INF increased from 41% pre-guideline to 60% post-guideline (p = .01) and unnecessary IV placement decreased from 24% to 0% (p = .002). Patients and parents preferred the IN route for analgesia administration. ConclusionA triage-based pain protocol utilizing INF did not reduce TTA, but did result in increased INF use, decreased unnecessary IV placement, and was preferred by patients and parents to IV medication. INF is a viable analgesia alternative for children with isolated extremity injuries.

Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review

Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using ketamine, pain or analgesia, and intranasal as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1 204 papers extracted via primary search, 1 088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.

Acute Pain Management in Emergency Department, Low Dose Ketamine Versus Morphine, A Randomized Clinical Trial.

BackgroundKetamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED).ObjectivesThis study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients.MethodsIn this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour.ResultsFifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90% and flushing) were significantly greater in the morphine group.ConclusionsThe results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine.

Intravenous acetaminophen versus morphine sulfate in pain management of acute renal colic: a randomized clinical trial

Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard. Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16. Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001). Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.

Intranasal Lidocaine for Primary Headache Management in Emergency Department; a Clinical Trial.

Most of the headache cases only require pain management in emergency department (ED). The present study aimed to evaluate the efficacy of intranasal lidocaine in this regard. In this clinical trial, adult patients with primary headache were randomly treated with 7.5 mg intravenous (IV) chlorpromazine and 1 ml intranasal lidocaine 2% (treatment) or normal saline 0.9% (placebo), and were compared 5, 15, and 30 minutes later regarding success rate using SPSS 21. 100 patients were assigned to either treatment or placebo group. Number needed to treat of intranasal lidocaine at 5, 15, and 30 minutes were 4 (95% CI: 2.2 - 6.6), 3 (95% CI: 1.7 - 3.5), and 4 (95% CI: 2.3 - 15.9), respectively. These measures for absolute risk reduction were 30 (95% CI: 15.2 - 44.8), 44 (95% CI: 28.7 - 59.3), and 26 percent (95% CI: 6.3 - 44.3), respectively. Pain relapse occurred in 16% of treatment and 11% of control group within 1 hour of treatment (p = 0.402). It seems that, intranasal lidocaine along with IV chlorpromazine could result in more successful and faster management of primary headaches in ED.

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program.

IntroductionOver 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures.MethodsWe performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation.ResultsWe studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001) than patients in the pre-GFP period.ConclusionImplementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.

Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial.

Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis. The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 - 0.64), 7 (95%CI: 3.7 - 23.1), and 20.71 (95%CI: 10.91 - 30.51), respectively. 280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p < 0.001). Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED.