EUSEM releases guidelines for acute pain management, treatment in ED

  • Hachimi-Idrissi S & al.
  • Intern Emerg Med
  • 22/09/2020

  • Kelli Whitlock Burton
  • Clinical Essentials
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  • The European Society for Emergency Medicine (EUSEM) has released evidence-based guidelines for the assessment and treatment of acute pain in emergency departments (EDs) in Europe.
  • The recommendations incorporate both pharmacological and nonpharmacological therapies. 
  • A multidisciplinary working group developed the recommendations as part of the European Pain Initiative.

Why this matters

  • Although pain is a common symptom at ED admission, consensus was lacking on standard of care in Europe.

Key recommendations

  • In all cases, consider use of nonpharmacological therapies such as splinting, immobilization, heat/cold, distraction, relaxation techniques, or acupressure to reduce the need for or amount of pain medication.
  • Paracetamol is recommended as first-line treatment for mild to moderate pain in adults and children, with optional use of NSAIDs, including the cyclooxygenase-2 inhibitor celecoxib where available, or oral opioids, but only for moderate pain.
  • Inhaled analgesia, including nitrous oxide or methoxyflurane, is recommended for moderate to severe pain while other analgesia is established.
  • Severe pain should be treated first with available opioids (morphine, fentanyl, or sufentanil) via intravenous (IV) or intranasal routes, with the option to add paracetamol and additional oral opioids if required.
  • Third-line anesthesia, if needed, is ketamine via IV, injection, or intranasal with careful attention to increased risk for adverse events in elderly patients.
  • For children, first-line analgesia with intranasal fentanyl or oral morphine should be considered and titrated to effect with IV paracetamol as second-line treatment.
  • Additional lines of treatment should only be offered if clinical need persists based on a pain assessment.