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Background Acute pain is a common condition among prehospital patients and prompt management is pivotal. Opioids are the most frequently analgesics used in the prehospital setting. However, opioids are highly addictive, and some patients may develop opioid dependence, even when they are exposed to brief opioid treatments. Therefore, alternative non-opioid analgesia should be developed to manage pain in the prehospital setting. Used at subdissociative doses, ketamine, a noncompetitive N- methyl-D-aspartate and glutamate receptor antagonist, provides analgesic effects accompanied by preservation of protective airway reflexes. In this context, we will carry out a randomized controlled, open-label, multicenter trial to compare a subdissociative dose of ketamine to morphine to provide pain relief in the prehospital setting, in patients with traumatic and non-traumatic pain. Methods/design This will be a multicenter, single-blind, randomized controlled trial. Consecutive adults will be enrolled in the prehospital setting if they experience moderate to severe, acute, non-traumatic and traumatic pain, defined as a numeric rating scale score greater or equal to 5. Patients will be randomized to receive ketamine or morphine by intravenous push. The primary outcome will be the between-group difference in mean change in numeric rating scale pain scores measured from the time before administration of the study medication to 30 min later. Discussion This upcoming randomized clinical trial was design to assess the efficacy and safety of ketamine, an alternative non-opiate analgesia, to manage non-traumatic and traumatic pain in the prehospital setting. We aim to provide evidence to change prescribing practices to reduce exposition to opioids and the subsequent risk of addiction. Trial registration ClinicalTrials.gov, ID: NCT03236805 . Registered on 2 August 2017.

We present the results of extensive strain- and stress-controlled rheometry performed on an AOT–water–iso-octane system, which forms lamellar structures with a high density of topological defects. In spite of different time-scales, both measurement methods, strain- and stress-controlled, are shown to be controlled by the level of strain experienced by the material. In both cases, after a complex transition, an apparent steady state is reached. Whereas both apparent steady states are identical for intermediate shear rate and shear stress following a power law, these are found to differ once the lower values of applied shear rate and shear stress are considered. The origin of this difference is discussed in terms of supplied energy to the sheared sample.

Midazolam comedication with morphine is a routine practice in pre and postoperative patients but has not been evaluated in prehospital setting. We aimed to evaluate the comedication effect of midazolam in the prehospital traumatic adults. A prehospital prospective randomized double-blind placebo-controlled trial of intravenous morphine 0.10 mg/kg and midazolam 0.04 mg/kg vs morphine 0.10 mg/kg and placebo. Pain assessment was done using a validated numeric rating scale (NRS). The primary end point was to achieve an efficient analgesic effect (NRS ≤ 3) 20 minutes after the baseline. The secondary end points were treatment safety, total morphine dose required until obtaining NRS ≤ 3, and efficient analgesic effect 30 minutes after the baseline. Ninety-one patients were randomized into midazolam (n = 41) and placebo (n = 50) groups. No significant difference in proportion of patients with a pain score ≤ 3 was observed between midazolam (43.6%) and placebo (45.7%) after 20 minutes (P = .849). Secondary end points were similar in regard with proportion of patients with a pain score ≤ 3 at T30, the side effects and adverse events except for drowsiness in midazolam vs placebo, 43.6% vs 6.5% (P < .001). No significant difference in total morphine dose was observed, that is, midazolam (14.09 mg ± 6.64) vs placebo (15.53 mg ± 6.27) (P = .315). According to our study, midazolam does not enhance pain control as an adjunctive to morphine regimen in the management of trauma-induced pain in prehospital setting. However, such midazolam use seems to be associated with an increase in drowsiness.