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Pain Management in the Emergency Department: An Update

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 March 2024) | Viewed by 9498

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Special Issue Editor

Dr. Andrea Fabbri

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Guest Editor

Emergency Department, AUSL della Romagna, Forlì, Italy
Interests: emergency medicine; brain injury; cardiovascular medicine; cardiology; risk stratification; acute heart failure; chest pain; cardiac arrest; sepsis; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pain is one of the main complaints of patients referred to the Emergency Department (ED), comprising over 50% of all causes. Pain treatment represents one of the quality-of-care indicators and markers for assessing care in patients attending the ED. Adequate treatment of pain is a moral and ethical imperative, since if not adequately treated, untreated pain can cause physical and psychological complications with additional unfavorable consequences, such as anxiety, depression, and social isolation. Emergency physicians should treat pain as soon as possible, with different strategies according to their experience and cultural background, making the right choice for each patient.

This Special Issue is a critical review of pain management in the ED, with particular attention to the whole spectrum of clinical conditions attending the ED. It is also a qualitative review of current descriptive studies of ED pain practice, as well as clinical trials of emerging pain treatment modalities. From an ED perspective, we welcome articles with new insights into 1) the effectiveness of analgesics, 2) different administration strategies and approaches, 3) novel therapeutic solutions and techniques, 4) management of pain that cannot be easily treated, and 5) palliative care.

Dr. Andrea Fabbri
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pain
emergency
analgesics
palliative care
opioids
treatment
management

Published Papers (3 papers)

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Research

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11 pages, 882 KiB

Open AccessArticle

Ultrasound-Guided Femoral Nerve Block in Geriatric Patients with Hip Fracture in the Emergency Department

by Tou-Yuan Tsai, Kar Mun Cheong, Yung-Cheng Su, Ming-Chieh Shih, Su Weng Chau, Mei-Wen Chen, Chien-Ting Chen, Yi-Kung Lee, Jen-Tang Sun, Kuan-Fu Chen, Kuo-Chih Chen and Eric H. Chou

J. Clin. Med. 2022, 11(10), 2778; https://doi.org/10.3390/jcm11102778 - 14 May 2022

Cited by 7 | Viewed by 2961

Abstract

Background and Objectives: Systemic analgesics, including opioids, are commonly used for acute pain control in traumatic hip fracture patients in the emergency department (ED). However, their use is associated with high rates of adverse reactions in the geriatric population. As such, the aim of this study was to investigate the impact of lidocaine-based single-shot ultrasound-guided femoral nerve block (USFNB) on the standard care for acute pain management in geriatric patients with traumatic hip fracture in the ED. Methods: This retrospective, single-center, observational study included adult patients aged ≥60 years presenting with acute traumatic hip fracture in the ED between 1 January 2017 and 31 December 2020. The primary outcome measure was the difference in the amount of opioid use, in terms of morphine milligram equivalents (MME), between lidocaine-based single-shot USFNB and standard care groups. The obtained data were evaluated through a time-to-event analysis (time to meaningful pain relief), a time course analysis, and a multivariable analysis. Results: Overall, 607 adult patients (USFNB group, 66; standard care group, 541) were included in the study. The patients in the USFNB group required 80% less MME than those in the standard care group (0.52 ± 1.47 vs. 2.57 ± 2.53, p < 0.001). The multivariable Cox proportional hazards regression models showed that patients who received USFNB achieved meaningful pain relief 2.37-fold faster (hazard ratio (HR) = 2.37, 95% confidence intervals (CI) = 1.73–3.24, p < 0.001). Conclusions: In geriatric patients with hip fractures, a lidocaine-based single-shot USFNB can significantly reduce opioid consumption and provide more rapid and effective pain reduction. Full article

(This article belongs to the Special Issue Pain Management in the Emergency Department: An Update)

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7 pages, 238 KiB

Open AccessBrief Report

Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

by Alessandro Riccardi, Sossio Serra, Fabio De Iaco, Andrea Fabbri, Dana Shiffer and Antonio Voza

J. Clin. Med. 2023, 12(9), 3124; https://doi.org/10.3390/jcm12093124 - 25 Apr 2023

Cited by 3 | Viewed by 2462

Abstract

This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation. Full article

(This article belongs to the Special Issue Pain Management in the Emergency Department: An Update)

26 pages, 685 KiB

Open AccessSystematic Review

Intranasal Fentanyl for Acute Pain Management in Children, Adults and Elderly Patients in the Prehospital Emergency Service and in the Emergency Department: A Systematic Review

by Sossio Serra, Michele Domenico Spampinato, Alessandro Riccardi, Mario Guarino, Rita Pavasini, Andrea Fabbri and Fabio De Iaco

J. Clin. Med. 2023, 12(7), 2609; https://doi.org/10.3390/jcm12072609 - 30 Mar 2023

Cited by 4 | Viewed by 3306

Abstract

This systematic review examined the efficacy and safety of intranasal fentanyl (INF) for acute pain treatment in children, adults, and the elderly in prehospital emergency services (PHES) and emergency departments (ED). ClinicalTrials.gov, LILACS, PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane databases were consulted until 31 December 2022. A total of 23 studies were included: 18 in children (1 PHES, 17 ED), 5 in adults (1 PHES, 4 ED) and 1 in older people (1 PHES subgroup analysis). In children, INF was effective in both settings and as effective as the comparator drugs, with no differences in adverse events (AEs); one randomised controlled trial (RCT) showed that INF was more effective than the comparator drugs. In adults, one study demonstrated the efficacy of INF in the PHES setting, one study demonstrated the efficacy of INF in the ED setting, two RCTs showed INF to be less effective than the comparator drugs and one RCT showed INF to be as effective as the comparator, with no difference in AEs reported. In older people, one study showed effective pain relief and no AEs. In summary, INF appears to be effective and safe in children and adults in PHES and ED. More high-quality studies are needed, especially in PHES and older people. Full article

(This article belongs to the Special Issue Pain Management in the Emergency Department: An Update)

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