Shop
   

 Home > Ambulance Stories > Medic Scribe

Non-Opioid Pain Management
written by Medic Scribe on the 05th October 2017 at 13:40

The state of Massachusetts just passed an emergency protocol change requiring all paramedic ambulances to carry non opioid pain management alternatives, including Ibuprofen PO, Acetaminophen PO and Ketorolac IV or IM.  Acetaminophen IV is optional.  The changes are to take place January 1, 2018.

Massachusetts Pain Management Protocol

Emergency Non-Opioid Pain Treatment Options Update

Here is the dosing regime:

Adult

Acetaminophen 1000 mg IV or PO

Ibuprofen 600 mg PO

Ketorolac  15 mg IV or 30 mg IM

Pediatric

Acetaminophen 15 mg/kg IV or PO to max 1000 mg.

Ibuprofen 10 mg/kg PO to max 600 mg.

Ketorolac 0.5 mg/kg IV or IM to max 15 mg.

The Massachusetts protocol includes the following note:

All pain medications have contraindications-do not administer medications in

such circumstances. These contraindications include but are not limited to:

Ketorolac and ibuprofen are contraindicated in head injury, chest pain, abdominal pain,

or in any patient with potential for bleeding, ulcer, or renal injury; likely to need surgery

Acetaminophen is contraindicated in patients with liver failure. Ketorolac and ibuprofen

are contraindicated in pregnancy.

Many states, including Massachusetts and Connecticut, have been passing laws allowing patients to fill out non-opioid directive forms.  This will allow patients who want to avoid opioids a pain management alternative beyond ice and splinting.  I have had many patients decline opioids, ranging from patients in recovery to  patient to others fearful that “Fentanyl” will send them down the road to addiction and death.  While those fears are largely unrealistic in the context of fentanyl being used for an acute painful injury, avoiding opioids if there is another alternative is probably not a bad idea.

I was not even aware that Acetaminophen  could be given by the IV route or that it was considered as effective as morphine, but a recent randomized controlled study published in Trauma Monthly showed it was safe and efficacious and even outperformed morphine in the trial.

Efficacy of Intravenous Paracetamol Versus Intravenous Morphine in Acute Limb Trauma.

One drawback to IV Acetaminophen is its price — $36 for a one dose 1 gram vial, compared to $2.40 a dose for fentanyl or morphine.  As it so often seems, the price of a suddenly popular drug seem to suddenly skyrocket.

When IV Acetaminophen Prices Suddenly Skyrocketed

IV APAP Works, So Why Don’t More EPs Use It?

Our Regional Medical Advisory Committee will be considering a similar protocol when we meet next week.  In our area, the cost of IV acetaminophen might be mitigated by the savings of not having to take an ambulance off-line for controlled substances exchanges at a hospital pharmacy every time they use Fentanyl or Morphine.


 Originally posted at http://www.medicscribe.com/2017/10/05/non-opioid-pain-management/...

Similar Stories

Pain Management Podcast Posted on 20th June 2013
EMS Opiates and Chronic Pain – 2 Posted on 15th March 2016
The Opioid Epidemic: The EMS Role (Free On-line CME) Posted on 28th September 2017
Pain – Why Call Now? Posted on 20th February 2012
These Go to 11 Posted on 19th March 2013