Femoral nerve blockade administered preclinically for pain relief in severe knee trauma is more feasible and effective than intravenous metamizole: a randomized controlled trial.

BACKGROUND: Before clinical treatment and during transportation, the analgesic therapy offered to patients with painful knee trauma may be quite insufficient. We hypothesize that a femoral nerve blockade for analgesia can be administered in a preclinical setting at the injury site and provides better pain relief than intravenous metamizole, whose analgesic effect is comparable with that of opioids. METHODS: After an initial clinical investigation, 52 patients were randomized according to computer-generated codes; 26 patients received a femoral nerve blockade and 26 received metamizole. The treatment was started at the injury site and the level of pain on the 100-mm visual analog scale was assessed at the beginning and the end of treatment. RESULTS: Pain and anxiety scores were significantly reduced by half in the femoral nerve blockade group; peripheral vasoconstriction was noted in 26 patients at the injury site and dropped to six at the time of arrival at the hospital. Two of 26 patients in the blockade group did not benefit from the treatment. In the metamizole group, pain and anxiety did not decrease significantly; vasoconstriction persisted in all patients. CONCLUSION: Patients with painful knee trauma benefited from femoral nerve blockade administered before hospitalization. The treatment can be administered safely in the preclinical setting and provides effective analgesia.

Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial.

BACKGROUND: Pain during transportation is a common phenomenon in emergency medicine. As acupressure has been deemed effective for pain management by the National Institutes of Health, we conducted a study to evaluate its effectiveness in prehospital patients with isolated distal radial fracture. METHODS: This was a prospective, randomized, double-blind study. Thirty-two patients were enrolled. Acupressure was performed either at "true" points or at "sham" points. Vital signs and pain and anxiety scores were recorded before and after the acupressure treatment. Normally distributed values were compared using the Student t test. RESULTS: Pretreatment scores for pain and anxiety were similar in the 2 groups (47.6 +/- 8.9 vs 51.2 +/- 8.7 visual analog scale [VAS] score for pain, 52.4 +/- 6.0 vs 47.5 +/- 9.3 VAS score for anxiety). At the hospital, patients in the true-points group had significantly lower pain (36.6 +/- 11.0 vs 56.0 +/- 13.3 VAS score, P < .001) and anxiety scores (34.9 +/- 22.2 vs 53.4 +/- 19.7 VAS score, P = .022). CONCLUSION: Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma.

Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly.

PURPOSE: Auricular acupuncture at the relaxation point has been shown to be effective treatment for anxiety. We hypothesized that auricular acupressure may decrease anxiety in elderly individuals who are transported by ambulance before receiving ESWL. MATERIALS AND METHODS: We enrolled 100 patients with renal calculi who were transported to the local hospital by special ambulance, accompanied by 2 paramedics. Paramedic 1 performed data collection, while paramedic 2 performed auricular acupressure in patients randomly assigned to a relaxation group and a sham treated group. Anxiety was measured using a visual analog scale score on a scale of 0 to 100 mm. RESULTS: Each group consisted of 50 patients with similar demographic characteristics. The relaxation group had significantly decreased anxiety scores upon arrival at the hospital and lower anticipation of pain scores (mean+/-SD 57.6+/-21.8 to 15.4+/-9.8 and 35.7+/-29.7 to 9.5+/-4.1 mm VAS) than the sham treated group (55.5+/-25.9 to 49.8+/-28.9 and 37.7+/-24.1 to 33.8+/-25.2 mm VAS, respectively, 2-way repeated measure ANOVA each p=0.001). Estimated waiting times for treatment did not differ significantly between the 2 groups (5.0+/-2.5 and 5.5+/-2.95, respectively, repeated measures ANOVA p=0.83). The Post-Intervention Anxiety visual analog scale demonstrated the significant superiority of the true treatment group (19.5+/-5.9 and 66.8+/-27.9 mm VAS, respectively, p=0.001). CONCLUSIONS: Elderly patients who received auricular acupressure at specific relaxation points while being transported to the hospital were less anxious, anticipated less pain and were more optimistic about the outcome of treatment that they will receive than the sham treated group. These data prove that this is an effective treatment for anxiety that improves the patient overall perception of ESWL.

The influence of stellate ganglion transcutaneous electrical nerve stimulation on signal quality of pulse oximetry in prehospital trauma care.

BACKGROUND: Accurate monitoring of the peripheral arterial oxygen saturation has become an important tool in the prehospital emergency medicine. This monitoring requires an adequate plethysmographic pulsation. Signal quality is diminished by cold ambient temperature due to vasoconstriction. Blockade of the stellate ganglion can improve peripheral vascular perfusion and can be achieved by direct injection or transcutaneous electrical nerve stimulation (TENS) stimulation. We evaluated whether TENS on the stellate ganglion would reduce vasoconstriction and thereby improve signal detection quality of peripheral pulse oximetry. METHODS: In our study, 53 patients with minor trauma who required transport to the hospital were enrolled. We recorded vital signs, including core and skin temperature before and after transport to the hospital. Pulse oximetry sensors were attached to the patient's second finger on both hands. TENS of the stellate ganglion was started on one side after the beginning of the transport. Pulse oximeter alerts, due to poor signal detection, were recorded for each side separately. RESULTS: On the hand treated with TENS we detected a significant reduction of alerts compared to the other side (mean alerts TENS 3.1 [1-15] versus control side 8.8 [1-28] P < 0.05). The duration of dropouts was shorter as well (mean duration TENS 77 [16-239] s versus control side 333 [78-1002] s). CONCLUSION: The data indicate that blockade of the stellate ganglion with TENS improves signal quality of pulse oximeters in the prehospital setting.

TENS relieves acute posttraumatic hip pain during emergency transport.

BACKGROUND: In Central Europe, ambulances for patients suffering from pain caused by nonlife-threatening trauma, such as hip fractures are staffed by medical personnel (medics) without physicians. Thus, there is an urgent need for nonpharmacological interventions that can be applied during the transport by basic life-support (BLS) medical personnel. METHODS: In all, 101 patients were screened for participation in this randomized placebo-controlled double-blind study, and randomly assigned to two groups (verum and sham transcutaneous electrical nerve stimulation [TENS]). First, medic A recorded all baseline parameters and measurements, then medic B performed TENS in absence of medic A. At the end of transportation, medic A performed data collection. Each patient was asked to grade his/her pain and anxiety level on visual analog scales (VAS, 0 to 100 mm). RESULTS: From 101 screened patients fulfilling the entry criteria, 29 declined consent and 9 had to be excluded from the analysis because of their final diagnosis. Therefore, the data from 30 patients (group 1, verum TENS) as well as from 33 patients (group 2 [control], sham TENS) were analyzed. No significant differences in potentially influencing factors were found before treatment. Pain scores upon arrival at the hospital differed significantly between group 1 and group 2 (p < 0.01). In group 1, pain reduction was observed between departure from the site of emergency and arrival at the hospital (VAS: 89 +/- 9 to 59 +/- 6 mm), whereas pain scores remained nearly unchanged in group 2 (VAS: 86 +/- 12 to 79 +/- 11 mm). CONCLUSION: Our findings show that TENS is a valuable and fast-acting pain treatment under the difficult circumstances of "out-of-hospital rescue". Because of its lack of side effects, it could also be a valuable tool in the hospital.

Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care.

PURPOSE: Acute renal colic is one of the most anguishing forms of pain in humans. We hypothesized that TENS is an effective pain treatment in patients with acute renal colic. MATERIALS AND METHODS: A total of 100 patients with acute flank pain and suspected renal colic consented to participate in our study. Paramedic 1 recorded baseline parameters at the emergency site and at the end of transportation. Paramedic 2 performed TENS in patients randomly assigned to G1 with actual TENS or to G2 with sham TENS. Pain and anxiety were measured using paper based visual analog scales on a scale of 0 to 100 mm. RESULTS: Of 100 screened patients 73 had renal colic, including 39 in G1 and 34 in G2. There was no significant difference with regard to potentially influencing factors, such as patient age, sex, weight, height, blood pressure and heart rate, pain, nausea and anxiety between the groups before treatment. G1 showed a significant mean pain decrease +/- SD of more than 50% (85.7 +/- 10.5 to 33.3 +/- 16.0 mm, p <0.01). G2 showed no variation in mean pain scores (85.8 +/- 18.0 to 82.6 +/- 14.3 mm). G1 showed changes in the mean anxiety score (69.0 +/- 8.4 to 37.7 +/- 15.1 mm, p <0.01), nausea score (90.7 +/- 9.2 to 44.9 +/- 22.0 mm) and heart rate (92 +/- 10 to 64 +/- 8 bpm), while G2 showed nonsignificant changes. CONCLUSIONS: This trial shows that local TENS is a rapid and effective treatment for renal colic pain. We found TENS to be a good nondrug therapy under the difficult circumstances of out of hospital rescue.

Out-of-hospital auricular acupressure in elder patients with hip fracture: a randomized double-blinded trial.

OBJECTIVES: Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport. The purpose of this randomized, double-blind, sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture. METHODS: With the assistance of the Vienna Red Cross, 38 patients with acute hip fracture were enrolled into this study. Patients were randomized into two study groups: the true intervention group and the sham control group. Subjects in the true intervention group (n = 18) received bilateral auricular acupressure at three auricular acupressure points for hip pain. Patients in the sham group (n = 20) received bilateral auricular acupressure at sham points. Baseline demographic information, anxiety level, pain level, blood pressure, and heart rate were obtained before the administration of the appropriate acupressure intervention. The level of anxiety, level of pain, hemodynamic profiles, and level of satisfaction were reassessed once the patients arrived at the hospital. RESULTS: Patients in the true intervention groups had less pain (F = 28, p = 0.0001) and anxiety (F = 4.3, p = 0.018) and lower heart rate (F = 18, p = 0.0001) on arrival at the hospital than did patients in the sham control group. As a result, the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital. CONCLUSIONS: The authors encourage physicians, health care providers, and emergency rescuers to learn this easy, noninvasive, and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation.

Transcutaneous electrical nerve stimulation as prehospital emergency interventional care: treating acute pelvic pain in young women.

Objectives. In Europe, patients with acute pelvic pain are transported to the hospital in an ambulance without an emergency physician. We hypothesized that transcutaneous electrical nerve stimulation (TENS) would be an effective noninvasive procedure for pain treatment. Methods. We conducted a prospective, randomized, blinded study where 100 women were randomly assigned into a real- or a sham-TENS group. TENS began before the transport to the ambulance and was left in place until the arrival at the hospital. Each patient rated her pain on paper using a visual analog scale. Results. Compared to sham TENS, patients with active TENS felt that their pain was reduced by half after treatment (p < 0.01), anxiety scores significantly decreased (p < 0.01), heart rate and arteriolar vasoconstriction decreased significantly (p < 0.01), and nausea (p < 0.01) was lessened. Overall satisfaction with the received care was significantly higher (p < 0.01). Conclusion. TENS is a safe, rapid, and effective analgesic treatment for acute pelvic pain.

Local active warming: an effective treatment for pain, anxiety and nausea caused by renal colic.

PURPOSE: Based on previous studies showing that warming decreases trauma pain in emergency care we hypothesized that local active warming of the abdomen and lower back region could decrease pain in acute renal colic cases during emergency transport. MATERIALS AND METHODS: After obtaining informed consent 100 patients were divided into 2 groups, including those who received active warming of the abdomen and lower back region (42C) and those who received no warming. Pain, nausea and anxiety were rated by the patients using visual analog scales. Statistical evaluation was performed using the t test with p <0.05 considered significant. RESULTS: In group 1 a significant pain decrease was recorded in all cases using a visual analog score (VAS) (82.7 +/- 9.5 to 36.3 +/- 16.0 mm VAS, p <0.01). In group 2 patient pain scores remained comparable (81.8 +/- 13.0 to 80.6 +/- 12.3 mm VAS). In group 1 anxiety significantly decreased (79.0 +/- 8.9 and 30.7 +/- 14.1 mm VAS before and after treatment, respectively, p <0.01). In group 2 a nonsignificant change in score was noted (79.7 +/- 20.5 to 75.2 +/- 19.7 mm VAS). In group 1 a significant decrease in nausea was recorded in all cases (85.7 +/- 11.2 to 40.6 +/- 23.0 mm VAS, p <0.01). In group 2 patient nausea scores remained comparable (79.2 +/- 22.0 to 80.3 +/- 22.4 mm VAS, respectively). CONCLUSIONS: Local active warming is an effective and easy to learn pain treatment for patients with acute renal colic in emergency care.

The influence of active warming on signal quality of pulse oximetry in prehospital trauma care.

UNLABELLED: Victims of trauma such as contusions and simple fractures are usually transported by paramedics. Because many victims are intoxicated with alcohol or other drugs, they are vulnerable to some risk of inadequate respiration. Thus, their oxygenation is monitored by noninvasive pulse oximetry. We tested the hypothesis that active warming of the whole body during transport to the hospital can improve the reliability of arterial oxygen saturation (SpO(2)) monitoring. Twenty-four trauma patients transported to hospital were included in the study and randomly assigned to two groups: one group (n = 12) was covered with normal wool blankets, and the other group (n = 12) was treated with resistive heating blankets during transport. We recorded core temperature, shivering, skin temperature at the forearm and finger, SpO(2), and hemodynamic variables. Before randomization, both groups were comparable. On arrival at the hospital, the actively warmed patients had significantly warmer core (36.1 +/- 0.3 degrees C versus 35.5 +/- 0.3 degrees C; P < 0.001) and skin (34.1 +/- 1.5 degrees C versus 24.9 +/- 1.4 degrees C; P < 0.001) temperatures. In the actively warmed group, the pulse oximeter had significantly fewer alerts (31 versus 58) and a significantly less time of malfunction (146 +/- 42 s versus 420 +/- 256 s) and provided more constant measurements in the actively warmed group (P < 0.001). In this study we showed that active warming improves pulse oximeter monitoring quality in trauma patients during transport to the hospital. IMPLICATIONS: Clinical trials show that pulse oximeter signal quality is limited by hypothermia. In this study we show that active whole-body warming of trauma victims improves monitoring quality during transport to the hospital.