Acute Pain Clinical Trial
Official title:
Is There an Ideal Dose of Intravenous Fentanyl in the Prehospital Setting: A Prospective Cluster-randomized Comparison of 2 vs. 3 μg/kg/Transport
In a previous study the investigators evaluated the apparent efficacy and safety of
intravenous fentanyl administered by ambulance personnel and found that 58.4% (CI 56.4-60.4)
out of 2348 prehospital patients treated with fentanyl still experienced moderate to severe
pain [numeric rating scale (NRS, 0-10) > 3] at hospital arrival. The number of patients with
possible fentanyl-related side effects was low.
Therefore, the aim of the present study is to explore the efficacy and safety of a
liberalized pain treatment protocol for ambulance personnel (a total of 3 μg/kg per
transport) compared with existing restrictive protocol (a total of 2 μg/kg per transport).
The investigators hypothesize that:
- A higher proportion of patients will experience sufficient pain relief at hospital
admission (NRS < 4) using the liberalized protocol and
- There will be no differences in the proportion of potential fentanyl related
side-effects are observed.
A prospective cluster-randomized trial observing proportional differences in sufficient pain
relief at hospital admission (NRS < 4) and potential fentanyl related side-effects between
patients treated by ambulance personnel applying either:
- a more liberal treatment approach (a total of 3 μg/kg per transport) or
- existing treatment approach (a total of 2 μg/kg per transport).
The Ambulance stations and their affiliated ambulance personnel are stratified into 5
clusters according to size/average transports per month and randomized to either liberal or
existing treatment approach within each cluster. As patients are not randomized on an
individual level baseline differences between the two groups and its patients are adjusted
statistically with relevant confounders on 3 overall levels:
1. Patients: Charlson Comorbidity Index Score, main overall diagnose category, inhospital
surrogate measures of disease severity (intensive care unit admission and 30-day
mortality).
2. Ambulance personnel: Years of experience and preinterventional cumulative fentanyl
administration and
3. Ambulance stations and geographical factors: prehospital time measures and geographical
distance from site of emergency to hospital.
These covariates are obtained from the Danish National Patient Registry, the Danish Civil
Registration System and the electronic prehospital patient journal.
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