• Damien Viglino, Nicolas Termoz Masson, Agnès Verdetti, Flore Champel, Cédric Falcon, Alexis Mouthon, Prudence Mabiala Makele, Collomb Muret Roselyne R Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France., Caroline Maindet Dominici, and Maxime Maignan.
• Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France.
• Intern Emerg Med. 2019 Oct 1; 14 (7): 1139-1145.

AbstractInsufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.

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