Prehospital Analgesia in Trauma: A Systematic Review of Current Evidence.

In 30 seconds

This systematic review assessed the safety and effectiveness of pharmacologic analgesia given before hospital arrival to acutely injured adults aged over 15 years. It included 17 studies involving 17,115 patients, covering opioids, ketamine, methoxyflurane and paracetamol. Across the studies, all agents showed effectiveness to varying degrees. No drug-attributed serious adverse events were reported except in one opioid study; minor effects, including nausea, dizziness, dysphoria, agitation and drowsiness, were common. The authors judged the overall evidence to support a favourable safety and effectiveness profile, while noting limitations in the evidence base.

Key findings

• The review included 17 studies involving 17,115 patients, with randomized and observational designs.
• All assessed agents—opioids, ketamine, methoxyflurane and paracetamol—showed effectiveness to varying levels.
• No drug-attributed serious adverse events were reported apart from one study of opioid therapy; minor adverse effects were common.

Why it matters

Pain is frequently undertreated in prehospital trauma care, while uncertainty about medication safety and effectiveness can complicate analgesia decisions. This review suggests that several pharmacologic options can provide benefit, with serious drug-attributed harms uncommon in the included studies. The findings also highlight that the evidence remains insufficiently consistent to resolve all questions about prehospital protocols.

What to keep in mind

The authors note that evidence is limited by its scope, methodology and variation in treatment protocols.