Table 5 Cumulative doses of opioids administered in prehospital studies
Author, year, country | Setting and providers | Design and sample | Adm. form | Opioid(s) | Protocol restrictions | Cumulative Doses | Equianalgesic i.v. Morphine dose |
|---|---|---|---|---|---|---|---|
Krauss et al. [17] USA 2011 | HEMS BLS and ALS (paramedic) | Single arm n = 500 | i.v. | Fentanyl | 5 μg/kg/hour | 3.0 μg/kg | 22.5 mga |
Bounes et al. [9] 2010 France | Two-tiered BLS and ALS (physician) | RCT n = 108 | i.v. i.v. | Morphine Sufentanil | None | 0.3 mg/kg 0.225 μg/kg | 22.5 mga |
Bounes et al. [10] 2007 France | Two-tiered BLS and ALS (physician) | RCT n = 106 | i.v. i.v. | Morphine Morphine | None | 0.225 μg/kg 0.3 mg/kg | 22.5 mga |
Bounes et al. [39] 2011 France | Two-tiered BLS and ALS (physician) | Observational n = 277 | i.v. i.v. | Morphine Sufentanil | N/A | 0.3 mg/kgb 0.23 μg/kgb | 22.5 mga 17.3 mga |
Galinski et al. [7] 2005 France | Two-tiered BLS and ALS (physician) | RCT n = 54 | i.v. i.v. | Morphine Fentanyl | None | 16 mg 150 μg | 16 mg 15 mg |
Albrecht et al. [5] 2013 Switzerland | HEMS BLS and ALS (physician) | Single arm n = 1202 | i.v. | Fentanyl | None | 157 μg | 15.7 mg |
Auffret et al. [46] 2014 France | Two-tiered BLS and ALS (physician) | RCT n = 85 | i.v. i.v. | Morphine Midazolam +Morphine | None | 15.5 mg 14.1 mg | 15.5 mg 14.1 mg |
Galinski et al. [11] 2007 France | Two-tiered BLS and ALS (physician) | RCT n = 65 | i.v. i.v. | Morphine Ketamine+ Morphine | None | 0.202 mg/kg 0.149 mg/kg | 15.2 mga |
Jennings et al. [8] 2007 Australia | Two-tiered BLS and ALS (paramedic) | RCT n = 135 | i.v. i.v. | Morphine Ketamine +Morphine | None | 15 mg 35 mg | 15 mg |
DeVellis et al. [64] 1998 USA | HEMS BLS and ALS (paramedic) | Single arm n = 130 | i.v. | Fentanyl | None | 144 μg | 14.4 mg |
Oberholzer et al. [29] 2017 Switzerland | HEMS BLS and ALS (physician) | Single arm n = 778 | i.v. i.v. i.v. | Fentanyl Morphine Ketamine | None | 140 μg 7 mg 58 mg | 14 mg 7 mg |
Johansson et al. [65] 2009 Sweden | Two-tiered BLS and ALS (nurse) | Non-RCT n = 27 | i.v. i.v. i.v. | Morphine Ketamine +Morphine | 0.2 mg/kg | 13.5 mg 27.9 mg 7.0 mg | 13.5 mg |
Frakes et al. [66] 2009 USA | HEMS BLS and ALS (paramedic) | Single arm n = 209 | i.v. | Fentanyl | 5 μg/kg/hour | 1.7 μg/kg | 12.8 mga |
McRae et al. [48] 2015 Australia | Two-tiered BLS and ALS (paramedic) | RCT n = 24 | i.v. reg. | Morphine Regional Block+ Morphine | 0.5 mg/kg | 7.5 mg + 5 mgb 5 mgb | 12.5 mg 5 mg |
Frakes et al. [67] 2006 USA | HEMS BLS and ALS (paramedic) | Single arm n = 100 | i.v. | Fentanyl | 5 μg/kg | 1.6 μg/kg | 12 mga |
Kanowitz et al. [16] USA 2006 | Two-tiered BLS and ALS (paramedic) | Single arm n = 2129 | i.v. | Fentanyl | None | 118 μg | 11.8 mg |
Friesgaard et al. Denmark 2017 | Two-tiered BLS and ALS (EMT-I) | cRCT n = 5278 | i.v. i.v. | Fentanyl Fentanyl | 3 μg/kg 2 μg/kg | 117.7 μg 111.5 μg | 11.8 mg |
Silfvast et al. [13] 2001 Finland | Two-tiered BLS and ALS (physician) | RCT n = 36 | i.v. i.v. | Morphine Alfentanil | 10 mg 1 mg | 10 mg 1 mg | 10 mg 9–15 mg |
Eidenbenz et al. [28] 2016 Switzerland | HEMS BLS and ALS (physician) | Single arm n = 1156 | i.v. i.v. i.n. | Fentanyl Ketamine Fentanyl | None | 100 μgb 30 mg 100 μg | 10 mg |
Smith et al. [6] 2010 USA | HEMS BLS and ALS (physician) | RCT n = 200 | i.v. i.v. | Morphine Fentanyl | 20 mg 250 μg | 4 mg 100 μg | 4 mg 10 mg |
Soriya et al. [68] 2011 USA | Two-tiered BLS and ALS (paramedic) | Before after n = 763 | i.v. | Fentanyl | 100 μg | 100 μg | 10 mg |
Richard Hibon et al. [69] 2008 France | Two-tiered BLS and ALS (physician) | Before after n = 216 | i.v. | Morphine | None | 9.5 mg | 9.5 mg |
Fleischman et al. [35] 2010 USA | Two-tiered BLS and ALS (paramedic) | Before after n = 718 | i.v. i.v. | Morphine Fentanyl | 20 mg 200 μg | 7.7 mg 92 μg | 7.7 mg 9.2 mg |
Friesgaard et al. [19] 2016 Denmark | Two-tiered BLS and ALS (EMT-I) | Single arm n = 2348 | i.v. | Fentanyl | 2 μg/kg | 90 μgb | 9.0 mgb |
Galinski et al. [36] 2010 France | Two-tiered BLS and ALS (physician) | Observational n = 2279 | i.v. | Morphine | N/A | 9.0 mg | 9.0 mg |
Lebon et al. [70] 2016 Canada | Two-tiered BLS and ALS (paramedic) | Single arm n = 288 | s.c. | Fentanyl | 3 μg/kg | 1.2 μg/kg | 9 mg |
Jennings et al. [58] 2010 Australia | Two-tiered BLS and ALS (paramedic) | Observational n = 315,273 | i.v. i.v. inh. | Fentanyl Morphine Methoxyflurane | N/A | 83.5 μg 7.6 mg 3.2 ml | 8.4 mg 7.6 mg |
Bakkelund et al. [71] 2013 Norway | Two-tiered BLS and ALS (EMT) | Single arm | i.v. | Morphine | N/A | 7.5 mgb | 7.5 mgb |
Ricard-Hibon et al. [51] 1999 France | Two-tiered BLS and ALS (physician) | Before after n = 213 | - i.v. | Analgesics Morphine | None | 7.2 mg | 7.2 mg |
Brown et al. [53] 2016 USA | Two-tiered BLS and ALS (paramedic) | Before after n = 2128 | i.v. i.v. | Morphine Morphine | 20 mg | 6.0 mg 7.1 mg | 6.0 mg 7.1 mg |
Fullerton-Gleason et al. [55] | Two-tiered BLS and ALS (paramedic) | Before after | i.v. i.v. | Morphine Morphine | N/A | 6.6 mg 6.7 mg | 6.6 mg 6.7 mg |
Zedigh et al. [47] 2010 Sweden | Two-tiered BLS and ALS (nurse) | RCT n = 164 | i.v. i.v. | Morphine Metoprolol +Morphine | 5 mg 5 mg | 5 mg 5 mg | 5 mg 5 mg |
Weldon et al. [12] 2016 Canada | Two-tiered BLS and ALS (paramedic) | RCT n = 207 | i.v. i.v. | Morphine Fentanyl | 20 mg 100 μg | 4,25 mg 42,5 μg | 4,25 mg 4,25 mg |
Bruns et al. [72] 1992 USA | Two-tiered BLS and ALS (paramedic) | Observational n = 89 | i.v. | Morphine |  | 4 mg | 4 mg |
Middleton et al. [61] 2010 Australia | Two-tiered BLS and ALS (paramedic) | Observational n = 42,844 | i.v. i.n. inh. | Morphine Fentanyl Methoxyflurane | 0.5 mg/kg None | N/A |  |
Bendall et al. [73] 2011 Australia | Two-tiered BLS and ALS (paramedic) | Single arm n = 97,705 |  | Morphine Fentanyl Methoxyflurane | N/A | N/A |  |
Thomas et al. [18] USA 2005 | HEMS BLS and ALS (paramedic) | Single arm n = 177 | i.v. | Fentanyl | 5 μg/kg/hour | N/A |  |
Tran et al. [45] 2014 Vietnam | Rural, low resource setting | cRCT n = 308 | i.m. i.v. | Morphine Ketamine | 10 mg 0.2–0.3 mg/kg | N/A |  |
Rickard et al. [15] 2007 Australia | Two-tiered BLS and ALS (paramedic) | RCT n = 258 | i.v. i.n. | Morphine Fentanyl | 15 mg 300 μg | N/A |  |
Vergnion et al. [14] Belgium | N/A | RCT n = 101 | i.v. i.v. | Morphine Tramadol | 20 mg 200 mg | N/A |  |