【罂粟摘要】芬太尼滴鼻与口服吗啡在儿科创伤中心骨折复位中的应用

 急诊科（ED）骨折复位中的疼痛管理对于减少手术室全麻下行骨折复位至关重要。本研究比较了芬太尼滴鼻（INF）与口服吗啡在儿童骨折复位护理时间及镇痛的有效性。

 在创伤中心的儿童急诊科进行了一项INF前后实施研究。研究对象为X线上证实闭合性移位骨折且须要进行复位和石膏固定的患儿。在3个连续阶段比较两种镇痛药的骨折复位护理时间、镇痛时间和疼痛的有效性和耐受性。

本研究共纳入77例儿童：31例接受口服吗啡，46例接受INF。INF组骨折复位操作时间较短（150 [111-193]分钟比215 [155-240]，P = 0.01），镇痛时间较短（10 [9-13]分钟比80 [53-119]，P < 0.001），INF给药后疼痛减轻程度更高（3 [0-4]比6 [3-7]，P < 0.001），药物消耗量更少（P = 0.002）。两组术前骨折疼痛评分相似（P = 0.15），但INF组给药后术前和术中疼痛显着降低，两组术后疼痛相当 （2 [0-4]比3 [0- 5]，P = 0.02；3 [1-5]比7 [3-9]，P < 0.001；两组1 [0-2]， P = 0.87）。INF组在术中保持较低的疼痛水平可扩展到下肢骨折复位手术（P = 0.04）。本研究未发生严重不良事件。

 INF获得的镇痛时间和骨折复位时间较短，但在骨折复位过程中镇痛效果更好，下肢骨折的患儿使用INF也可获得同样效果。因此，这种快速有效的镇痛有助于儿童ED的骨科护理，否则须要在手术室全身麻醉下进行骨折复位。

原始文献来源：Bisso R, Tielli A, Lopes AA. Intranasal Fentanyl Versus Morphine in Fracture Reduction in a Pediatric Trauma Center. J Am Acad Orthop Surg. Published online August 30, 2024.

Intranasal Fentanyl Versus Morphine in Fracture Reduction in a Pediatric Trauma Center

Purpose: Pain management in orthopaedic manipulation in the emergency department (ED) is crucial to decrease fracture reduction performed in the operating room. This study compared intranasal fentanyl (INF) with oral morphine in time of care and effectiveness on pain during the reduction of bone fractures in a pediatric trauma center.

Methods: A before-and-after INF implementation study was conducted in a pediatric ED with a trauma center on children with a confirmed displaced closed fracture on radiographs with reduction and casting performed in the ED. The time of care, time for sufficient analgesia, effectiveness on pain, and tolerance were compared between both analgesics in 3 consecutive phases.

Results: 77 children were included: 31 children received oral morphine and 46 INF. The time of care was shorter in the INF group (150 [111 to 193] minutes versus 215 [155 to 240], P = 0.01) as the time for sufficient analgesia (10 [9 to 13] minutes versus 80 [53 to 119], P < 0.001) with a higher pain reduction after a dose of INF (3 [0 to 4] versus 6 [3 to 7], P < 0.001) and less dose requirement (P = 0.002). Although pain scores were similar at arrival in both groups (P = 0.15), the pain was significantly lower before and during the procedure in the INF group and equivalent after the procedure (2 [0 to 4] versus 3 [0 to 5], P = 0.02, 3 [1 to 5] versus 7 [3 to 9], P < 0.001, and 1 [0 to 2] in both groups, P = 0.87, respectively). Keeping pain levels low during the procedure in the INF group allowed the extension to lower limb fracture reductions (P = 0.04). No serious adverse events were reported.

Conclusion: INF reduces the time to obtain sufficient analgesia and time of care, with good effectiveness maintained during the procedure in fracture reduction, allowing the extension to lower limb fractures. Thus, this rapid and efficient analgesia facilitates orthopaedic care in the pediatric ED that would otherwise require to be reduced in the operating room under general anesthesia.