PUB - Publikationen an der Universität Bielefeld

BACKGROUND: Despite the development of various analgesic concepts, prehospital oligoanalgesia remains very common. The present work examines prehospital analgesia by paramedics using morphine vs. nalbuphine+paracetamol.; METHODS: Patients with out-of-hospital-analgesia performed by paramedics from the emergency medical services of the districts of Fulda (morphine) and Gutersloh (nalbuphine+paracetamol) were evaluated with regards to pain intensity at the beginning and the end of prehospital treatment using the Numeric-Rating-Scale for pain (NRS), sex, age, and complications. The primary endpoint was achievement of adequate analgesia, defined as NRS<4 at hospital handover, depending on the analgesics administered (nalbuphine+paracetamol vs. morphine). Pain intensity before and after receiving analgesia using the NRS, sex, age and complications were also monitored.; RESULTS: A total of 1,808 patients who received out-of-hospital-analgesia were evaluated (nalbuphine+paracetamol: 1,635 (90.4%), NRS-initial: 8.0±1.4, NRS-at-handover: 3.7±2.0; morphine: 173(9.6%), NRS-initial: 8.5±1.1, NRS-at-handover: 5.1±2.0). Factors influencing the difference in NRS were: initial pain intensity on the NRS (regression coefficient (RK): 0.7276, 95%CI: 0.6602-0.7950, p<0.001), therapy with morphine vs. nalbuphine+paracetamol (RK: -1.2594, 95%CI: -1.5770 - -0.9418, p<0.001) and traumatic vs. non-traumatic causes of pain (RK: -0.2952, 95%CI: -0.4879 - -0.1024, p=0.002). Therapy with morphine (n=34 (19.6%)) compared to nalbuphine+paracetamol (n=796 (48.7%)) (odds ratio (OR): 0.274, 95%CI: 0.185-0.405, p<0.001) and the initial NRS score (OR:0.827, 95%CI: 0.771-0.887, p<0.001) reduced the odds of having an NRS<4 at hospital handover. Complications occurred with morphine in n=10 (5.8%) and with nalbuphine+paracetamol in n=35 (2.1%) cases. Risk factors for complications were analgesia with morphine (OR: 2.690, 95%CI: 1.287-5.621, p=0.008), female sex (OR: 2.024, 95%CI: 1.040-3.937, p=0.0379), as well as age (OR: 1.018, 95%CI: 1.003-1.034, p=0.02).; CONCLUSIONS: Compared to morphine, prehospital analgesia with nalbuphine+paracetamol yields favourable effects in terms of analgesic effectiveness and a lower rate of complications and should therefore be considered in future recommendations for prehospital analgesia. © 2024. The Author(s).