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Russian Sklifosovsky Journal "Emergency Medical Care"

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Management of Trauma Pain in the Emergency Medicine

https://doi.org/10.23934/2223-9022-2025-14-1-178-185

Abstract

The literature review is devoted to modern principles of acute pain management of traumatic genesis in the practice of emergency medical care. It describes the capability of pain intensity evaluation, and available methods of analgesia and pain relief medication. Special emphasis is laid on current data on inhaled methoxyflurane analgesia.

About the Authors

V. J. Pikovskii
Russian University of Medicine; A.S. Puchkov Ambulance and Emergency Medical Care Station
Russian Federation

Vadim Yu. Pikovskii - Candidate of Medical Sciences, Associate Professor, Department of Emergency Medical Care, Russian University of Medicine; Chief Freelance Specialist in Anesthesiology and Resuscitation, A.S. Puchkov Ambulance and Emergency Medical Care Station.

Dolgorukovskaya Str. 4, Moscow, 127006; 1st Koptelsky per. 3, bldg. 1, Moscow, 129090



V. I. Barklaya
Russian University of Medicine
Russian Federation

Vadim I. Barklaya - Candidate of Medical Sciences, Associate Professor, Department of Emergency Medical Care, Russian University of Medicine.

Dolgorukovskaya Str. 4, Moscow, 127006



P. A. Davidov
A.S. Puchkov Ambulance and Emergency Medical Care Station
Russian Federation

Petr A. Davidov - Deputy Chief Physician, A.S. Puchkov Ambulance and Emergency Medical Care Station.

1st Koptelsky per. 3, bldg. 1, Moscow, 129090



References

1. Kalyuzhnyy LV. Fiziologicheskie mekhanizmy regulyatsii bolevoy chuvstvitel’nosti. Moscow: Meditsina Publ.; 1984. (In Russ.)

2. Shukhov VS. Bol’. Klinicheskie rekomendatsii po vedeniyu bol’nykh s razlichnymi bolevymi sindromami. RMJ. 2004;(7):437–444 (In Russ.)

3. European Society for Emergency Medicine. Guidelines for the management of acute pain in emergence situations; 2020. Available from: https://www.eusem.org/images/EUSEM_EPI_GUIDELINES_MARCH_2020.pdf. (Accessed February 28, 2025.)

4. Boonstra AM, Stewart RE, Köke AJ, Oosterwijk RF, Swaan JL, Schreurs KM, et al. Cut-off points for mild, moderate and severe pain on numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466. PMID: 27746750 https://doi.org/10.3389/fpsyg.2016.01466 eCollection 2016.

5. Lynch ME. The need for a Canadian pain strategy. Pain Res Manag. 2011;16(2):77–80. PMID: 21499581 https://doi.org/10.1155/2011/654651

6. Dale J, Bjornsen LP. Assessment of pain in a Norwegian emergency department. Scand J Trauma Resusc Emerg Med. 2015;23:86. PMID: 26514633 https://doi.org/10.1186/s13049-015-0166-3

7. Mura P, Serra E, Marinangeli F, Patti S, Musu M, Piras I, et al. Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department. J Pain Res. 2017;10:2781–2788. PMID: 29263692 https://doi.org/10.2147/JPR.S137992 eCollection 2017.

8. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989;7(6):620–623. PMID: 2803357 https://doi.org/10.1016/0735-6757(89)90286-6

9. Tainter CR. An evidence-based approach to traumatic pain management in the emergency department. Emerg Med Pract. 2012;14(8):1–26. PMID: 22916717

10. Berben SA, Schoonhoven L, Meijs TH, van Vugt AB, van Grunsven PM. Prevalence and relief of pain in trauma patients in emergency medical services. Clin J Pain. 2011;27(7):587–592. PMID: 21505324 https://doi.org/10.1097/AJP.0b013e3182169036

11. Hall JK, Boswell MV. Ethics, law, and pain management as a patient right. Pain Physician. 2009;12(3):499–506. PMID: 19461819

12. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manage. 2003;25(5):406–411. PMID: 12727037 https://doi.org/10.1016/s0885-3924(03)00162-3

13. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38:633–638. PMID: 11719741 https://doi.org/10.1067/mem.2001.118863

14. Gausche-Hill M, Brown KM, Oliver ZJ, Sasson C, Dayan PS, Eschmann NM, et al. An evidence-based guideline for prehospital analgesia in trauma. Prehosp Emerg Care. 2014;18(Suppl 1):25–34. PMID: 24279813 https://doi.org/10.3109/10903127.2013.844873

15. Fabbri A, Voza A, Riccardi A, Serra S, Iaco F; Study and Research Center of the Italian Society of Emergency Medicine (SIMEU). The Pain Management of Trauma Patients in the Emergency Department. J Clin Med. 2023;12(9):3289. PMID: 37176729. https://doi.org/10.3390/jcm12093289.

16. Hatherley C, Jennings N, Cross R. Time to analgesia and pain score documentation best practice standards for the emergency department – a literature review. Australas Emerg Nurs J. 2016;19(1):26–36. PMID: 26718064 https://doi.org/10.1016/j.aenj.2015.11.001

17. Prikaz Minzdrava Rossii ot 20 iyunya 2013 goda No 388n “Ob utverzhdenii Poryadka okazaniya skoroy, v tom chisle skoroy spetsializirovannoy, meditsinskoy pomoshchi (s izmeneniyami na 21 fevralya 2020 goda)”. Moscow; 2020. (In Russ.) Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/053/356/original/388í.pdf?1608118780 (Accessed 03.03.2025)

18. Prikaz Mintruda Rossii ot 14.03.2018 No 133n “Ob utverzhdenii professional’nogo standarta “Vrach skoroy meditsinskoy pomoshchi”. Moscow; 2018. (In Russ.) Available at: http://publication.pravo.gov.ru/Document/View/0001201804090002 (Accessed 03.03.2025)

19. Prikaz Mintruda Rossii ot 27.08.2018 No 554n “Ob utverzhdenii professional’nogo standarta “Vrach anesteziolog-reanimatolog”. Moscow; 2018. (In Russ.) Available at: http://publication.pravo.gov.ru/Document/View/0001201809170020 (Accessed 03.03.2025)

20. Prikaz Mintruda Rossii ot 13.01.2021 No 3n “Ob utverzhdenii professional’nogo standarta “Fel’dsher skoroy meditsinskoy pomoshchi”. Moscow; 2021. (In Russ.) Available at: http://publication.pravo.gov.ru/Document/View/0001202104120032 (Accessed 03.03.2025)

21. Prikaz Minzdrava Rossii ot 28.10.2020 No 1165n “Ob utverzhdenii trebovaniy k komplektatsii lekarstvennymi preparatami i meditsinskimi izdeliyami ukladok i naborov dlya okazaniya skoroy meditsinskoy pomoshchi” (s izmeneniyami i dopolneniyami)”. Moscow; 2020. (In Russ.) Available at: http://publication.pravo.gov.ru/Document/View/0001202011260027 (Accessed 03.03.2025)

22. Porter KM, Siddiqui MK, Sharma I, Dickerson S, Eberhardt A. Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison. J Pain Res. 2018;11:11–21. PMID: 29302193 https://doi.org/10.2147/JPR.S150600 Collection 2018.

23. Mikhaylovich VA, Miroshnichenko AG. (eds.) Rukovodstvo dlya vrachey skoroy meditsinskoy pomoshchi. 4th ed. Saint Petersburg; 2007. (In Russ.)

24. Bagnenko SF (ed.) Skoraya meditsinskaya pomoshch’. Klinicheskie rekomendatsii. Moscow; 2023. (In Russ.)

25. Wadlund DL. Local anesthetic systemic toxicity. AORN J. 2017;106(5):367–377. PMID: 29107256 https://doi.org/10.1016/j.aorn.2017.08.015

26. McRae PJ, Bendall JC, Madigan V, Middleton PM. Paramedic-performed fascia iliaca compartment block for femoral fractures: a controlled trial. J Emerg Med. 2015;48(5):581–589. PMID: 25661312 https://doi.org/10.1016/j.jemermed.2014.12.016

27. Slade S, Hanna E, Pohlkamp-Hartt J, Savage DW, Ohle R. Efficacy of Fascia Iliaca Compartment Blocks in Proximal Femoral Fractures in the Prehospital Setting: A Systematic Review and Meta-Analysis. Prehosp Disaster Med. 2023;38(2):252–258. PMID: 36912109 https://doi.org/10.1017/S1049023X23000298

28. Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Rev Bras Anestesiol. 2015;65(3):191–199. PMID: 25925031 https://doi.org/10.1016/j.bjane.2014.05.001

29. Weibel S, Jelting Y, Pace NL, Helf A, Eberhart LH, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6(6):CD009642. PMID: 29864216 https://doi.org/10.1002/14651858.CD009642.pub3

30. Farahmand S, Hamrah H, Arbab M, Sedaghat M, Basir Ghafouri H, Bagheri-Hariri S. Pain management of acute limb trauma patients with intravenous lidocaine in emergency department. Am J Emerg Med. 2018;36(7):1231–1235. PMID: 29254669 https://doi.org/10.1016/j.ajem.2017.12.027

31. Clattenburg EJ, Nguyen A, Yoo T, Flores S, Hailozian C, Louie D, et al. Intravenous lidocaine provides similar analgesia to intravenous morphine for undifferentiated severe pain in the emergency department: a pilot, unblinded randomized controlled trial. Pain Med. 2019;20(4):834–839. PMID: 29741660 https://doi.org/10.1093/pm/pny031

32. Hewes HA, Dai M, Mann NC, Baca T, Taillac P. Prehospital pain management: disparity by age and race. Prehosp Emerg Care. 2018;22(2):189–197. PMID: 28956669 https://doi.org/10.1080/10903127.2017.1367444

33. Hoeffe J, Doyon Trottier E, Bailey B, Shellshear D, Lagacé M, Sutter C, et al. Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: the FAN observational study. Am J Emerg Med. 2017;35(5):710–715. PMID: 28190665 https://doi.org/10.1016/j.ajem.2017.01.004

34. Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001;92(6):1543–1546. PMID: 11375843 https://doi.org/10.1097/00000539-200106000-00039

35. Beakley BD, Kaye AM, Kaye AD. Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain Physician. 2015;18(4):395–400. PMID: 26218943

36. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25(8):977–980. PMID: 17920984 https://doi.org/10.1016/j.ajem.2007.02.040

37. Zietlow J, Berns K, Jenkins D, Zietlow S. Prehospital use of ketamine: effectiveness in critically ill and injured patients. Mil Med. 2019;184(Suppl 1):542–544. PMID: 30901477 https://doi.org/10.1093/milmed/usy422

38. Rueda Carrillo L, Garcia KA, Yalcin N, Shah M. Ketamine and its Emergence in the field of neurology. Cureus. 2022;14(7):e27389. PMID: 36046286 https://doi.org/10.7759/cureus.27389 eCollection 2022 Jul.

39. Reede K, Bartholomew R, Nielsen D, Ahmeti M, Zreik K. Ketamine in Trauma: A Literature Review and Administration Guidelines. Cureus. 2023;15(11):e48099. PMID: 37920424 https://doi.org/10.7759/cureus.48099

40. Vertkin AL, Topolyanskiy AV, Vovk EI, Naumov AV. Mesto ketorolaka v terapii ostrykh bolevykh sindromov na dogospital’nom etape. Ambulance Doctor. 2006;(6):1–6. (In Russ.)

41. Forrest JB, Camu F, Greer IA, Kehlet H, Abdalla M, Bonnet F, et al.; POINT Investigators. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaesth. 2002;88(2):227–233. PMID: 11883386 https://doi.org/10.1093/bja/88.2.227

42. Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133(3):741–755. PMID: 24572864 https://doi.org/10.1097/01.prs.0000438459.60474.b5

43. Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2017;70(2):177–184. PMID: 27993418 https://doi.org/10.1016/j.annemergmed.2016.10.014

44. McCarthy DT. Prehospital analgesia: multimodal considerations. Br J Anaesth. 2013;110(5):849. PMID: 23599525 https://doi.org/10.1093/bja/aet094

45. Pikovskiy VY, Barklaya VI. Ketorol at a Prehospital Stage. Emergency Medical Care. 2009;(3):53–57. (In Russ.)

46. Coffey F, Dissmann P, Mirza K, Lomax M. Methoxyflurane analgesia in adult patients in the emergency department: a subgroup analysis of a randomized, double-blind, placebo-controlled study (STOP!). Adv Ther. 2016;33:2012–2031. PMID: 27567918 https://doi.org/10.1007/s12325-016-0405-7

47. Ducassé JL, Siksik G, Durand-Béchu M, Couarraze S, Vallé B, Lecoules N, et al. Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial. Acad Emerg Med. 2013;20(2):178–184. PMID: 23406077 https://doi.org/10.1111/acem.12072

48. Kalvi TN, Uil’yams NE. Farmakologiya dlya anesteziologa. Moscow; 2007. (In Russ.)

49. Davies DM, Ferner RE, de Glanville H. Davies’ textbook of adverse drug reactions. 5th edition. London, Chapman and Hall Medical; 1998.

50. Cousins ML, Mazze RI. Methoxyflurane nephrotoxicity. A study of dose-response in man. JAMA. 1973;225:1611–1616. PMID: 4740737 https://doi.org/10.1001/jama.225.13.1611

51. Dayan AD. Analgesic use of inhaled methoxyflurane: evaluation of its potential nephrotoxicity. Hum Exp Toxicol. 2016;35(1):91–100. PMID: 25926525 https://doi.org/10.1177/0960327115578743

52. Spruyt O, Westerman D, Milner A, Bressel M, Wein S. A randomised, double-blind, placebo-controlled study to assess the safety and efficacy of methoxyflurane for procedural pain of a bone marrow biopsy. BMJ Support Palliat Care. 2014;4(4):342–348. PMID: 24644183 https://doi.org/10.1136/bmjspcare-2013-000447

53. Jacobs IG. Health effects of patients given methoxyflurane in the pre-hospital setting: a data linkage study. Open Emerg Med J. 2010;3:7–13. https://doi.org/10.2174/1876542401003010007

54. Coffey F, Wright J, Hartshorn S, Hunt P, Locker T, Mirza K, et al. STOP!: a randomised, double-blind, placebo-controlledstudy of the efficacy and safety of methoxyflurane for the treatment of acute pain. Emerg Med J. 2014;31(8):613–618. PMID: 24743584 https://doi.org/10.1136/emermed-2013-202909

55. Blair HA, Frampton JE. Methoxyflurane: a review in trauma pain. Clin Drug Investig. 2016;36(12):1067–1073. PMID: 27738897 https://doi.org/10.1007/s40261-016-0473-0

56. Johnston S, Wilkes GJ, Thompson JA, Ziman M, Brightwell R. Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service. Emerg Med J. 2011;28(1):57–63. PMID: 20466829 https://doi.org/10.1136/emj.2009.078717

57. Oxer HF. Effects of Penthrox (methoxyflurane) as an analgesic on cardiovascular and respiratory functions in the pre-hospital setting. J Mil Veterans Health. 2016;24:14–20. https://doi-ds.org/doilink/05.2021-18784211/JMVHVol24No2

58. Frangos J, Mikkonnen., Down C. Derivation of an occupational exposure limit for an inhalation analgesic methoxyflurane (Penthrox). Regul Toxicol Pharmacol. 2016;80:210–225. PMID: 27181451 https://doi.org/10.1016/j.yrtph.2016.05.012

59. Ruff R, Kerr S, Kerr D, Zalcberg D, Stevens J. Occupational exposure to methoxyflurane administered for procedural sedation: an observational study of 40 exposures. Br J Anaesth. 2018;120(6):1435–1437. PMID: 29793614 https://doi.org/10.1016/j.bja.2018.01.029

60. Borland M, Jacobs I, King B, O’Brien D. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med. 2007;49(3):335–340. PMID: 17067720 https://doi.org/10.1016/j.annemergmed.2006.06.016

61. Tvieta T, Thoner J, Klepstad P, Dale O, Jystad A, Borchgrevink PC. A controlled comparison between single doses of intravenous and intramuscular morphine with respect to analgesic effects and patient safety. Acta Anaesthesiol Scand. 2008;52(7):920–925. PMID: 18702754 https://doi.org/10.1111/j.1399-6576.2008.01608.x

62. Middleton PM, Simpson PM, Sinclair G, Dobbins TA, Math B, Bendall JC. Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care. 2010;14(4):439–447. PMID: 20809687 https://doi.org/10.3109/10903127.2010.497896

63. Lim KJ, Koh ZX, Ng YY, Fook-Chong S, Ho AFW, Doctor NE, et al. Comparison of inhalational methoxyflurane (Penthrox®) and intramuscular tramadol for prehospital analgesia. Singapore Med J. 2021;62(6):281–286. PMID: 32179922 https://doi.org/10.11622/smedj.2020035

64. Verdier J, Leduc A, Duteille F, Bertrand-Vasseur A, Perrot P. Use of methoxyflurane on acute pain during burn dressing in adult consultation. Ann Chir Plast Esthet. 2020;65(2):141–146. PMID: 31300241 https://doi.org/10.1016/j.anplas.2019.06.007

65. Smith MD, Rowan E, Spaight R, Siriwardena AN. Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study. BMC Emerg Med. 2022;22(1):122. PMID: 35799131 https://doi.org/10.1186/s12873-022-00664-y


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For citations:


Pikovskii V.J., Barklaya V.I., Davidov P.A. Management of Trauma Pain in the Emergency Medicine. Russian Sklifosovsky Journal "Emergency Medical Care". 2025;14(1):178-185. (In Russ.) https://doi.org/10.23934/2223-9022-2025-14-1-178-185

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ISSN 2223-9022 (Print)
ISSN 2541-8017 (Online)