Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
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引用次数: 0

Abstract

Background

Parenteral ketorolac and intravenous (IV) acetaminophen have been used for prehospital analgesia, yet limited data exist on their comparative effectiveness.

Study Objectives

To evaluate the comparative effectiveness of IV acetaminophen and parenteral ketorolac for analgesia in the prehospital setting.

Methods

We conducted a retrospective cross-sectional evaluation of patients receiving IV acetaminophen or parenteral ketorolac for pain management in a large suburban EMS system between 1/1/2019 and 11/30/2021. The primary outcome was change in first to last pain score. Subgroup analysis was performed on patients with traumatic pain. We used inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the treatment effect of acetaminophen versus ketorolac among all patients and the subgroup of those with traumatic pain.

Results

Of 2178 patients included, 856 (39.3%) received IV acetaminophen and 1322 (60.7%) received parenteral ketorolac. The unadjusted mean change in pain score was −1.9 (SD 2.4) for acetaminophen group and −2.4 (SD 2.4) for ketorolac. In the propensity score analyses, there was no statistically significant difference in pain score change for the acetaminophen group versus ketorolac among all patients (mean difference, IPTW: 0.11, 95% confidence interval [CI] −0.16, 0.37; PSM: 0.15, 95% CI −0.13, 0.43) and among those with traumatic pain (unadjusted: 0.18, 95% CI −0.35, 0.72; IPTW: 0.23, 95% CI −0.25, 0.71; PSM: −0.03, 95% CI −0.61, 0.54).

Conclusions

We found no statistically significant difference in mean pain reduction of IV acetaminophen and parenteral ketorolac for management of acute pain.

静脉注射对乙酰氨基酚与酮咯酸用于院前镇痛:回顾性数据综述
研究目的 评估院前镇痛中静脉注射对乙酰氨基酚和肠外酮咯酸的比较效果。方法 我们对 2019 年 1 月 1 日至 2021 年 11 月 30 日期间郊区大型急救系统中接受静脉注射对乙酰氨基酚或肠外酮咯酸治疗的患者进行了回顾性横断面评估。主要结果是首次到最后一次疼痛评分的变化。对有创伤性疼痛的患者进行了分组分析。我们使用逆概率治疗加权(IPTW)和倾向得分匹配(PSM)估算了对乙酰氨基酚与酮咯酸在所有患者和外伤性疼痛患者亚组中的治疗效果。结果 在纳入的 2178 名患者中,856 人(39.3%)接受了静脉对乙酰氨基酚治疗,1322 人(60.7%)接受了肠外酮咯酸治疗。对乙酰氨基酚组未经调整的疼痛评分平均变化为-1.9(标清2.4)分,酮咯酸组为-2.4(标清2.4)分。在倾向评分分析中,对乙酰氨基酚组与酮咯酸组的疼痛评分变化在所有患者中(平均差异,IPTW:0.11,95% 置信区间 [CI]-0.16,0.37;PSM:0.15,95% CI -0.13,0.43)和外伤性疼痛患者中(未调整:0.18,95% CI -0.35,0.72;IPTW:0.23,95% CI -0.25,0.71;PSM:-0.03,95% CI -0.35,0.72)无统计学显著差异:-结论我们发现,静脉注射对乙酰氨基酚和肠外注射酮咯酸治疗急性疼痛的平均镇痛效果在统计学上没有显著差异。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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