Safety of Intranasal Fentanyl in the Out-of-Hospital Setting: A Prospective Observational Study - 19/05/14
Abstract |
Study objective |
Initial out-of-hospital analgesia is sometimes hampered by difficulties in achieving intravenous access or lack of skills in administering intravenous opioids. We study the safety profile and apparent analgesic effect of intranasal fentanyl in the out-of-hospital setting.
Methods |
In this prospective observational study, we administered intranasal fentanyl in the out-of-hospital setting to adults and children older than 8 years with severe pain resulting from orthopedic conditions, abdominal pain, or acute coronary syndrome refractory to nitroglycerin spray. Patients received 1 to 3 doses of either 50 or 100 μg, and the ambulance crew recorded adverse effects and numeric rating scale (0 to 10) pain scores before and after treatment.
Results |
Our 903 evaluable patients received a mean cumulative fentanyl dose of 114 μg (range 50 to 300 μg). There were no serious adverse effects and no use of naloxone. Thirty-six patients (4%) experienced mild adverse effects: mild hypotension, nausea, vomiting, vertigo, abdominal pain, rash, or decrease of Glasgow Coma Scale score to 14. The median reduction in pain score was 3 (interquartile range 2 to 5) after fentanyl administration.
Conclusion |
The out-of-hospital administration of intranasal fentanyl in doses of 50 to 100 μg is safe and appears effective.
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: ST and JBD designed the study and obtained research funding. APHK and DMBP conducted the data collection. APHK analyzed data and drafted the article. JBD and MSH were the primary revisers, though all authors contributed substantially to the revision. JBD takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). APHK was funded by The Ambulance Company Falck. ST and DMBP were employed by Falck during the study period. The study is reported according to the Strengthening the Reporting of Observational studies in Epidemiology guidelines. |
Vol 63 - N° 6
P. 699-703 - juin 2014 Retour au numéro
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