Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology. The systematic review includes studies from 2000 and up to 2020 that focus on children’s prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results. The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious. The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.

中文翻译：

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儿科院前疼痛管理的有效性和安全性：系统评价

就儿童院前疼痛管理中使用的药物的严重程度和不良事件而言，具有临床意义的疼痛减轻尚未得到足够重视。因此，本系统评价旨在对数据库进行全面搜索，以检查缓解急性疼痛儿科患者院前疼痛的首选药物，无论其病因如何。系统评价包括从 2000 年到 2020 年的研究，重点是儿童院前疼痛管理。研究方案在 PROSPERO 中注册，注册号。CRD42019126699。包括使用任何类型的镇痛药和所有给药途径的药理学疼痛管理。主要结果是（1）可测量的疼痛减轻（有效性）和（2）没有发生任何严重的不良事件。在 PubMed、Medline、Embase、CINAHL、Epistemonikos 和 Cochrane 图书馆中进行了检索。最后，使用乔安娜布里格斯研究所 (JBI) 清单评估偏倚风险，并由于结果的异质性进行了文本叙述分析。目前关于镇痛药物在儿童院前疼痛缓解中的有效性和安全性的系统评价共确定了 8 篇文章。大多数审查的文章确定了镇痛药物，如芬太尼（鼻内/静脉注射）、吗啡（静脉注射）、甲氧氟烷（吸入）和氯胺酮（静脉注射/注射给药）。检查了芬太尼、吗啡和甲氧氟烷的作用，并评估了所有包含的镇痛药物的有效性。芬太尼、甲氧氟烷和氯胺酮的不良事件也有报道，尽管这些都没有被认为是严重的。系统评价显示，芬太尼、吗啡、甲氧氟烷和复方药物是院前儿童有效的镇痛药物。服用芬太尼、甲氧氟烷和氯胺酮后没有报告严重的不良事件。与其他镇痛药相比，鼻内芬太尼和吸入甲氧氟醚似乎是院前儿童首选的药物，因为它们易于给药、效果相似且安全性高。但纳入研究的证据水平（LOE）只有三四级，因此有必要进一步研究。服用芬太尼、甲氧氟烷和氯胺酮后没有报告严重的不良事件。与其他镇痛药相比，鼻内芬太尼和吸入甲氧氟醚似乎是院前儿童首选的药物，因为它们易于给药、效果相似且安全性高。但纳入研究的证据水平（LOE）只有三四级，因此有必要进一步研究。服用芬太尼、甲氧氟烷和氯胺酮后没有报告严重的不良事件。与其他镇痛药相比，鼻内芬太尼和吸入甲氧氟醚似乎是院前儿童首选的药物，因为它们易于给药、效果相似且安全性高。但纳入研究的证据水平（LOE）只有三四级，因此有必要进一步研究。