Author/Authors :
Yousefifard, Mahmoud Prevention of Cardiovascular Disease Research Center - Shahid Beheshti University of Medical Sciences, Tehran , Askarian-Amiri, Shaghayegh Physiology Research Center - Iran University of Medical Sciences, Tehran , Madani Neishaboori, Arian Physiology Research Center - Iran University of Medical Sciences, Tehran , Sadeghi, Mostafa Department of Anesthesiology and Critical Care - Tehran University of Medical Sciences, Tehran , Saberian, Peyman Department of Anesthesiology - Tehran university of Medical Sciences, Tehran , Baratloo, Alireza Prehospital and Hospital Emergency Research Center - Tehran University of Medical Sciences, Tehran
Abstract :
Introduction: A standard guideline concerning pre-hospital pain management is still a matter of discussion.
Therefore, the current umbrella review is determined to perform a comprehensive search in databases and Grey
literature and collect and summarize the guidelines and protocols dealing with prehospital pain management.
Methods: In the present study, all of the available guidelines and protocols concerning pre-hospital pain management were reviewed. Presented guidelines are from 2010 up to present, as the majority of guidelines are
considered old and become renewed after 10 years. Finally, the development quality of each guideline was
evaluated using AGREE II instrument. Results: The search conducted in databases and non-indexed protocols
resulted in inclusion of 12 pre-hospital pain management guidelines. The time interval of the guidelines was
from 2010 to 2019. Four guidelines were designed for pain management in trauma patients and other guidelines
were presented for all of the clinical conditions associated with pain. All of the 12 included guidelines presented
pain management instructions in adults. Pain management in children was reported in 10 guidelines. All of
the guidelines persisted on a standard method for pain evaluation. Pain management was categorized in three
groups; mild, moderate and severe pain. Most of the guidelines recommend paracetamol as an optional treatment for management of mild pain in both adults and children. In management of moderate and severe pain,
fentanyl and morphine were suggested for both adults and children. In most of the treatment guidelines fentanyl
is the optional choice for children. Conclusion: The present umbrella review has summarized the current evidence in pre-hospital pain management for the first time via investigation of guidelines and protocols related to
the matter. Based on the obtained evidence, no guideline is yet presented concerning opioid-free management
of moderate and severe pain. The evidence is insufficient for using non opioid medications such as ketamine.
Keywords :
Pain management , practice guideline , drug therapy , Emergency Medical Services
