Prehospital Analgesia in Trauma: A Systematic Review of Current Evidence

Pain management is integral to prehospital trauma care. However, due to multiple challenges, pain is frequently undertreated despite important physiologic and psychologic implications. Among these challenges is uncertainty regarding the safety and effectiveness of pharmacologic agents administered enroute. We aimed to evaluate the level of evidence for the safety and effectiveness of prehospital pharmacologic analgesia for acutely injured adult trauma patients. An electronic database search of PUBMED, Google Scholar, Cochrane Library, Embase and Scopus for studies that reported on safety and/or effectiveness of prehospital pharmacologic analgesia for acutely injured adults (aged > 15 years) from January 1st, 2014, to January 1st, 2026. Non-original studies, paediatric studies, studies of non-pharmacologic agents or non-systemic administration (e.g., topical) were excluded. Seventeen studies, involving 17,115 patients, met the inclusion criteria. The studies consisted of 6 randomized controlled trials, 5 retrospective cohort studies, one retrospective comparative study, one retrospective observational study, two prospective observational studies, one prospective cohort study and one non-randomized clinical trial. Agents included opioids, ketamine, methoxyflurane and paracetamol. Apart from one study of opioid therapy, no drug-attributed serious adverse events were reported. Minor adverse effects such as nausea, dizziness, dysphoria, agitation and drowsiness were common. All agents demonstrated effectiveness to varying levels. Current evidence demonstrates an overall favourable safety and effectiveness profile of prehospital analgesia for adult trauma patients. However, considering the wide prehospital prevalence of injury-related pain, evidence is limited by scope, methodology and variations of treatment protocols.