Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice

Lipp, C; Dhaliwal, Raj; Lang, Eddy

doi:10.1186/cc12521

Cited by 17 publications

(7 citation statements)

References 46 publications

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“…Current evidence and recommendations for pain management in the ED have typically focused on monotherapeutic pharmacologic interventions . By contrast, in other clinical settings, such as the postoperative and primary care settings, pain management has evolved from monotherapeutic treatments to a multimodal approach using combinations of opioid and nonopioid medications, local anesthetics, and nonpharmacologic interventions.…”

Section: Discussionmentioning

confidence: 99%

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Sakamoto

Ward

Vissoci

et al. 2018

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Sakamoto

Ward

Vissoci

et al. 2018

Academic Emergency Medicine

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“…Also, only two patients in the NG groups [ 12 ] in all of the included studies required non-opiate analgesia for pain and the others required no analgesia for re-feeding pain. Therefore, it is logical to speculate that the degree of re-feeding pain was not high according to the GRADE (Grading Assessment, Development and Evaluation) framework [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis

et al. 2013

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IntroductionEnteral feeding can be given either through the nasogastric or the nasojejunal route. Studies have shown that nasojejunal tube placement is cumbersome and that nasogastric feeding is an effective means of providing enteral nutrition. However, the concern that nasogastric feeding increases the chance of aspiration pneumonitis and exacerbates acute pancreatitis by stimulating pancreatic secretion has prevented it being established as a standard of care. We aimed to evaluate the differences in safety and tolerance between nasogastric and nasojejunal feeding by assessing the impact of the two approaches on the incidence of mortality, tracheal aspiration, diarrhea, exacerbation of pain, and meeting the energy balance in patients with severe acute pancreatitis.MethodWe searched the electronic databases of the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE. We included prospective randomized controlled trials comparing nasogastric and nasojejunal feeding in patients with predicted severe acute pancreatitis. Two reviewers assessed the quality of each study and collected data independently. Disagreements were resolved by discussion among the two reviewers and any of the other authors of the paper. We performed a meta-analysis and reported summary estimates of outcomes as Risk Ratio (RR) with 95% confidence intervals (CIs).ResultsWe included three randomized controlled trials involving a total of 157 patients. The demographics of the patients in the nasogastric and nasojejunal feeding groups were comparable. There were no significant differences in the incidence of mortality (RR = 0.69, 95% CI: 0.37 to 1.29, P = 0.25); tracheal aspiration (RR = 0.46, 95% CI: 0.14 to 1.53, P = 0.20); diarrhea (RR = 1.43, 95% CI: 0.59 to 3.45, P = 0.43); exacerbation of pain (RR = 0.94, 95% CI: 0.32 to 2.70, P = 0.90); and meeting energy balance (RR = 1.00, 95% CI: 0.92 to 1.09, P = 0.97) between the two groups. Nasogastric feeding was not inferior to nasojejunal feeding.ConclusionsNasogastric feeding is safe and well tolerated compared with nasojejunal feeding. Study limitations included a small total sample size among others. More high-quality large-scale randomized controlled trials are needed to validate the use of nasogastric feeding instead of nasojejunal feeding.

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“…Patients reported pain as their primary reason twice as often as providers reported a primary diagnosis of pain (~40% vs ~20%) [10]. In the USA and Canada multicenter research showed that 70 % of emergency patients suffer moderate and severe pain in ED but only 60% of patients receive analgesics [12]. A study done in Nigeria revealed that after analgesia delivery 85 % of patients in ED felt severe and moderate pain [13].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study

Andualem

Lema

Nigatu

et al. 2018

Pain Research and Treatment

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Background Adequate pain management has led to increased comfort in emergency patients, reducing morbidity and improving long term outcomes. Different pain management modalities have been applied in the emergency department among which systemic analgesia is commonly used by preceding a nerve block. Several factors have been associated with poor pain management in low resource setting areas. We aimed to determine pain management modalities and associated factors among emergency surgical patients. Patients and Methods After obtaining ethical approval from Ethical Review Committee, 203 volunteer patients were enrolled. Institutional based cross-sectional prospective study was conducted from April to May 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured through Numerical Rating Scale and statistical analysis was performed using SPSS statistical package version 23. Descriptive statistics cross-tab and binary logistics were performed to identify factors related to pain management in emergency department. Results A total of 203 patients, 138 (68%) males and 65 (32%) females with response rate of 94%, participated in this study. Among them, 66% patients received analgesia within two hours of ED presentation with a mean ± SD of 61.0 ± 34.1 minutes. 70.4 % of patients complained of moderate and severe pain after receiving analgesia. There was a significant difference between trauma and nontrauma patients in mean time of analgesia receiving and residual pain severity (p < 0.001). Age, trauma, physician pain assessment, and severity of pain were the predicting factors for analgesia delivery. Conclusion The overall practice of pain management in Gondar University Specialized Hospital Emergency Department was not adequate. Therefore, it is vital to implement an objective pain assessment method and documentation of the pain severity to improve pain management practice.

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Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice

Cited by 17 publications

References 46 publications

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study

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