Page 41 - JSOM Fall 2023

Use of Intranasal Analgesia in French Armed Forces

A Cross-Sectional Survey

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Romain Montagnon, MD *; Pierre-Julien Cungi, MD ; Olivier Aoun, MD, MSc ;
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Gabriel Morand, MD ; Jérôme Desmottes, MD ; Pierre Pasquier, MD, MSc ;
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Stéphane Travers, MD ; Luc Aigle, MD ; Christophe Dubecq, MD 9
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ABSTRACT
Background: Pain management is essential in military medi- difficult peripheral venous access. As such, IN route seemed
cine, particularly in Tactical Combat Casualty Care (TCCC) a relevant option as it can be both rapid and non-invasive.
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during deployments in remote and austere settings. The few However, few publications were available about INA that
previously published studies on intranasal analgesia (INA) highlighted its relevance and rare minor adverse effects. To our
focused only on the efficacy and onset of action of the medi- knowledge, the use of INA was never assessed in a military
cations used (ketamine, sufentanil, and fentanyl). Side-effects setting.
were rarely reported. The aim of our study was to evaluate
the use of intranasal analgesia by French military physicians. The objective of our study was to evaluate the use of INA by
Methods: We carried out a multicentric survey between 15 French military physicians.
January and 14 April 2020. The survey population included all
French military physicians in primary-care centers (n = 727) or Methods
emergency departments (n = 55) regardless of being stationed
in mainland France or French overseas departments and terri- Study Population
tories. Results: We collected 259 responses (33% responsive- We carried out a multicentric survey between 15 January and
ness rate), of which 201 (77.6%) physicians reported being 14 April 2020. We included all French military physicians
familiar with INA. However, regarding its use, of the 256 phy- in primary-care centers (n = 727) or emergency departments
sicians with completed surveys, only 47 (18.3%) had already (n = 55) regardless of being stationed in mainland France or
administered it. Emergency medicine physicians support- French overseas departments and territories. Reservists, in-
ing highly operational units (e.g., Special Forces) were more terns, and intensivists were excluded.
familiar with this route of administration and used it more
frequently. Ketamine was the most common medication used Data Collection
(n = 32; 57.1%). Finally, 234 (90%) respondents expressed an The questionnaire was prepared using JotForm (www.jotform

interest in further education on INA. Conclusion: Although .com) and then emailed to the included population on 15 Janu-
a majority of French military physicians who replied to the ary 2020, followed by three reminders on 5 February, 5 March,
survey were familiar with INA, few used it in practice. This and 5 April 2020 (Appendix A). Data collected included bi-
route of administration seems to be a promising medication ographical data on the responders, and their knowledge,
for remote and austere environments. Specific training should, use, and thoughts on the relevance of INA. In addition, for
therefore, be recommended to spread and standardize its use. those familiar with the technique, five additional multi-choice
questions (MCQ) were added. A grade from 0 to 5 was then
Keywords: Intranasal route; disaster medicine; emergency assigned according to the criteria (Appendix A). Data were
medicine; prehospital care; military medicine; analgesia; then entered into Excel (Microsoft, https://www.microsoft
ketamine; special operations .com/en-us/microsoft-365/excel).
Statistical Analysis
All statistical tests were performed using SPSS 25.0 software
Background
(IBM, https://www.ibm.com/products/spss-statistics). The quan-
Pain management is essential in military medicine, particularly titative variables were shown as average values using standard
in TCCC. In modern conflicts, evacuation to a Role 2 or deviations and ranges. Student’s T-test or the Mann- Whitney
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Role 3 facility can take many hours, as in Operation Barkhane U-test were used to compare the groups, provided that the
in the vast Sahelo-Saharan region (5 million km area from necessary parameters were met. The qualitative variables were
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Mauritania to Chad). In these situations, appropriate prehos- shown as percentages. They were then compared using the Chi-
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pital analgesia might sometimes be limited or delayed, due to squared test or the Fisher’s exact test if the theoretical numbers
*Correspondence to r.montagnon@yahoo.fr
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1 Dr Romain Montagnon is a physician affiliated with the 171th Medical Unit, Caylus, France. Dr Pierre-Julien Cungi is a physician affiliated
with the Department of Anesthesiology and Intensive Care, Sainte-Anne Military Training Hospital, Toulon, France. Dr Olivier Aoun is a phy-
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sician affiliated with the 5th Armed Forces Medical Center, Strasbourg, France. Dr Gabriel Morand and Dr Christophe Dubecq are physicians
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affiliated with the 4th Specialized Medical Unit, Bayonne, France. Dr Jérôme Desmottes is a physician affiliated with the Accident & Emergency
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Department, Sainte-Anne Military Training Hospital, Toulon, France. Dr Pierre Pasquier is a physician affiliated with the Special Operation
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Forces Medical Headquarters, Villacoublay, France. Dr Stéphane Travers is a physician affiliated with the Paris Fire Brigade Medical Emergency
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Department, Paris, France. Dr Luc Aigle is a physician affiliated with the French Military Health Service Academy, Bron, France.
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