RESUMO
Background In the last two decades, drug overdose has globally become a major player in patients' morbidity and mortality events. Opioids, in particular, have been always the main part of this equation in different communities as they correspond, for instance, to one-third of poisoning deaths in The United States of America (USA). Aim This study aimed to measure the variation in opioid-analgesia (OA) prescription behavior among emergency medicine (EM) physicians working in different hospitals in the Western Region of Saudi Arabia. Subjects and methods This is a cross-sectional study conducted among EM physicians in the Western Region of Saudi Arabia. A self-administered questionnaire was distributed among EM physicians using an electronic online survey. The questionnaire includes basic demographic characteristics and a 22-item questionnaire to assess opioid-prescribing behavior. Results A hundred and fifty-nine physicians took part in the study (male 61.6% vs female 38.4%). Of them, 59.7% were aged 23-30 years old, and junior residents constituted 35.1%. The factors that were associated with the most variable behavior were being aged 36-40 years old (p<0.001) and having more than 10 years in practice (p=0.007). The highest self-rated determinant factors were the apparent level of patients' distress, types of medications that were given, physicians' concerns about side effect profiles, patients' diagnoses, and pain scores. Conclusion EM physicians demonstrated an overall comparable prescribing behavior. Progression of physicians' age and years of practice both significantly affected our participant behavior. The highest self-rated prescribing factors were patients' distress level and the previously given medications. Further research is needed in order to implement better practical guidelines.
RESUMO
Opioids are the mainstay of treatment for acute pain in the emergency department. However, its misuse led to the investigation of alternative effective analgesic options for acute pain complaints such as ketamine. Therefore, this systematic review and meta-analysis aimed to determine the effectiveness of ketamine in comparison to opioids in the management of acute pain. This was a systematic review and meta-analysis of randomized controlled trials comparing ketamine to opioids for the relief of acute pain in the ED. Eligible studies were identified by searching the following electronic databases: Medline, Embase, and Central. Studies utilizing either the visual analog scale (VAS) or the numeric rating scale (NRS) for pain scoring in ketamine vs opioids were included. The revised Cochrane risk-of-bias tool for randomized trials was utilized. A random-effects model was performed, and all outcomes were pooled by the inverse variance weighting method. The total number of studies that met the criteria of systematic reviews was nine of which seven of them were included in the meta-analysis with 789 participants. The overall effect of NRS trials was the standardized mean difference (SMD) = -0.07, 95% confidence interval (CI) -0.31 to 0.17, P-value = 0.56, I2 =85%. While VAS trials showed an overall effect of SMD = -0.02, 95% CI -0.22 to 0.18, P = 0.84, I2 = 59%). Moreover, higher adverse events were reported in opioids; however, this was not statistically significant (SMD = 1.23, 95% CI 0.93-1.64, P = 0.15, I2 =38%). Ketamine for immediate pain relief at 15 minutes could be an effective alternative to opioids, but its overall effect in comparison to opioids for improving the pain has not shown a statistically significant difference. There was high heterogeneity in the included studies; thus, a sub-group analysis was performed.
