Does the standard intravenous solution of fentanyl (50 µg/mL) administered intranasally have analgesic efficacy?


  • Dianne Crellin, RN, BN, MN, NP, Nurse Practitioner/Lecturer; Rong Xiu Ling, BSc, Medical student; Franz E Babl, MD, MPH, FRACP, FAAPFACEP, Paediatric Emergency Physician.

Ms Dianne Crellin, The University of Melbourne, Emergency Department, Royal Children's Hospital, Parkville, Vic. 3055, Australia. Email:


Background:  Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the ED. A concentrated solution of fentanyl (300 µg/mL) has been used in prior trials, yet many ED use the standard solution at a concentration of 50 µg/mL, which is widely available and of low cost. We set out to determine if this lower concentration of fentanyl is also efficacious.

Methods:  Prospective audit in children aged 5–18 years presenting with upper limb injuries. Patients received IN fentanyl (50 µg/mL) at 1.5 µg/kg. Patient assessed pain scores were collected 5, 10, 20, 30 and 60 min following IN fentanyl administration using a visual analogue scale or Bieri Faces – Revised scale. Parental scores were used if patients were unable to provide a score.

Results:  Of the 59 eligible patients, 36 were enrolled; median age was 6.8 years (range 5–15 years), and 89% (32/36) ultimately required fracture reduction. Median first dose of IN fentanyl was 1.4 µg/kg. Median pain scores dropped from 7 (interquartile range 5–10) pre-fentanyl to 5 (interquartile range 4–8) at 5 min and 2 (interquartile range 1–4) at 30 and 60 min. A total of 21 (58%) children did not require further analgesia in the ED. There were no adverse events.

Conclusions:  Standard i.v. concentration IN fentanyl (50 µg/mL) appears to have analgesic efficacy in children with upper limb injuries.