Less IS less: a randomised controlled trial comparing cautious and rapid nalbuphine dosing regimens
| Autor: | Woollard, M, Whitfield, R, Smith, K, Jones, T, Thomas, G, Hinton, C |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Chest Pain Emergency Medical Services Analgesic Vital signs Nalbuphine Critical Care and Intensive Care Medicine Chest pain Drug Administration Schedule law.invention Randomized controlled trial law Medicine Humans Dosing Adverse effect Aged Pain Measurement Dose-Response Relationship Drug business.industry General Medicine Middle Aged Analgesics Opioid Regimen Anesthesia Emergency Medicine Prehospital Care Wounds and Injuries Female medicine.symptom Analgesia business medicine.drug |
| Popis: | Objective: This study aimed to determine which of two paramedic administered nalbuphine dosing regimens combined the greater analgesic effect with the minimum of adverse events. Methods: Patients suffering from chest pain or trauma were randomised to receive either a rapid dosing regimen (10 mg over 30 seconds, repeated once after three minutes if pain score remained above three) or a cautious regimen (5 mg over two minutes, repeated at three minute intervals if pain score remained above three to a maximum dose of 20 mg). Data were collected on analgesic effectiveness, changes in vital signs, and patient reported side effects. Results: The pain score fell by a mean of 4.29 and 3.49 in the rapid and cautious regimen groups respectively (difference = 0.79, 95% CI 0.09 to 1.5, p = 0.028). However, over half the patients in both groups continued to suffer significant pain on arrival at hospital. There were no significant changes in vital signs after nalbuphine, but there was a greater incidence of patient reported drowsiness in rapid regimen patients (42% compared with 21%, 95% CI = 6.96 to 34.12%, p = 0.003). Conclusion: A rapid dosing regimen of nalbuphine using 10 mg increments is more effective than and equally as safe as a cautious regimen using 5 mg increments. Further research is required to determine if a maximum dose exceeding 20 mg would result in fewer patients continuing to suffer significant pain before arrival at hospital. |
| Databáze: | OpenAIRE |
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