Objective Emergency physicians have become hesitant to treat patients with opioids because of downstream sequelae related to opioid use disorder. We enrolled a prospective cohort to determine whether the experience of a patient receiving an intravenous (IV) opioid was associated with multiple opioid prescriptions. Specifically, we tested whether greater improvements in pain and a larger euphoric response could predict which previously opioid-naive patients exposed to IV opioids would fill at least two opioid prescriptions in the subsequent 6 months. Methods We recorded pain scores (range, 0–10) before and 15 minutes after opioid-naive emergency department patients were given IV opioids to manage severe pain. We also determined opioid-induced euphoria (range, 0–10 points) by querying how good, how high, how much euphoria the opioid caused, and how likely the participant was to want the opioid again. Sixmonth outcomes were ascertained using the state prescription monitoring database. Results Among 506 patients, 32 (6.3%) filled at least two prescriptions during the 6 months following the emergency department visit. TThere were no differences between those who filled ≥2 prescriptions and those who did not with regard to pain relief (P=0.54), how good the medication made participants feel (P=0.91), how high the medication made participants feel (P=0.97), how much euphoria the opioid caused (P=0.23), or how likely the participant was to want the medication again (P=0.37). Conclusion Filling at least two opioid prescriptions was uncommon after initial exposure to therapeutic IV opioids and was unrelated to either analgesic efficacy or opioid-induced euphoria.
Objective Ketamine is a promising drug for analgesia in emergency medicine, but the high rate of side effects is a barrier to widespread usage. We hypothesized that ketamine bolus followed by ketamine infusion would provide a more even and longer duration of analgesia and lower rates of side effects in comparison to bolus-only administration.
Methods This was a double-blinded clinical trial. Eligible trauma patients were randomly allocated with the numeric rating scale ≥6 in two study groups. The first group received a dose of 0.3 mg/kg of ketamine over 1 minute, followed by an infusion of saline 0.9% over the next 30 minutes (bolus-only group). The second group was given 0.15 mg/kg of ketamine over 1 minute, followed by an infusion of 0.15 mg/kg over the next 30 minutes (bolus-and-infusion group). The primary outcome was to measure the average reduction in pain scores.
Results In total, 80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (all P<0.001). After 30 minutes, patients in the bolus-and-infusion group reported lower pain scores in all intervals with lower rates of need for rescue analgesia, but this difference was not statistically significant. Vital signs remained stable during the study in both groups. No statistically significant difference was observed between study groups for any side effect (P<0.05).
Conclusion Both administration protocols resulted in significant pain control. No statistically significant difference was observed between study groups in terms of analgesic efficacy and side effects.
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Updated European Society for Emergency Medicine Guidelines for acute pain management in emergency departments and prehospital care Saïd Hachimi-Idrissi, Viliam Dobias, Wolf E. Hautz, Robert Leach, Carlos Lojo Rial, Thomas C. Sauter, Idanna Sforzi, Frank Coffey European Journal of Emergency Medicine.2026; 33(3): 152. CrossRef
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Objective Pain control for hip fractures is often achieved via intravenous opioids. However, opioids can have dangerous adverse effects, including respiratory depression and delirium. Peripheral nerve blockade is an alternative option for pain control that reduces the need for opioid analgesia. The purpose of this study was to compare the use of femoral nerve blocks versus standard pain control for patients with hip fractures. Methods This retrospective study included adult patients presenting to the emergency department with isolated hip fractures between April 2021 and September 2022. The intervention group included all patients who received a femoral nerve block during this time. An equivalent number of patients who received standard pain control during that period was randomly selected to represent the control group. The primary outcome was preoperative opioid requirement, assessed by morphine milligram equivalents (MMEs). Results During the study period, 90 patients were included in each group. Mean preoperative MME was 10.3 (95% confidence interval [CI], 7.4–13.2 MME) for the intervention group and 14.0 (95% CI, 10.2–17.8 MME) for the control group (P=0.13). Patients who received a femoral nerve block also had shorter time from emergency department triage to hospital discharge (7.2 days; 95% CI, 6.2–8.0 days) than patients who received standard care (8.6 days; 95% CI, 7.210.0 days). However, this difference was not statistically significant (P=0.09). Conclusion Femoral nerve blockade is a safe and effective alternative to opioids for pain control in patients with hip fractures.
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In recent years, several techniques of regional anesthesia have been proposed to provide analgesia to the anterior thoracic cage; notably, most of these techniques require a parasternal approach. However, in this context, the potential role of a more common and well-established technique, namely the modified pectoral nerve block (known as PECS II block), has been poorly investigated. Here, we describe a case involving a patient with bilateral anterolateral multiple rib fractures associated with sternum fracture, who was successfully treated using bilateral PECS II blocks. Our experience indicates that the PECS II block can provide excellent analgesia in cases involving anterior rib and sternum fractures. Because it is easier to perform and may be safer than other parasternal techniques, the PECS II block should be considered when providing analgesia for traumatic injuries of the anterior thorax.
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Objective To evaluate intravenous lidocaine’s safety and efficacy as an analgesic agent in the treatment of a variety of painful conditions presenting to the emergency department.
Methods This case series identified seventeen patients who received lidocaine over a six month period and recorded demographic data, amount of lidocaine administered, the amount of opioid medication administered before and after lidocaine, pre- and post-lidocaine pain scores, and any qualitative descriptors of the patient’s pain recorded in the record. Side effects and adverse events were also recorded.
Results Of the seven patients who had a pre- and post-lidocaine pain score recorded, the mean reduction was 3 points on a 10 point scale. Patients who received lidocaine used less opioid medication. One patient received an improperly high dose of lidocaine and suffered a brief seizure and cardiac arrest, but was quickly resuscitated.
Conclusion This series suggests that lidocaine may be a useful adjunct in the treatment of acutely painful conditions in the emergency department.
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