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.
Does the standard intravenous solution of fentanyl (50 µg/mL) administered intranasally have analgesic efficacy?
Article first published online: 9 FEB 2010
© 2010 The Authors. Journal compilation © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 22, Issue 1, pages 62–67, February 2010
How to Cite
Crellin, D., Ling, R. X. and Babl, F. E. (2010), Does the standard intravenous solution of fentanyl (50 µg/mL) administered intranasally have analgesic efficacy?. Emergency Medicine Australasia, 22: 62–67. doi: 10.1111/j.1742-6723.2010.01257.x
- Issue published online: 9 FEB 2010
- Article first published online: 9 FEB 2010
- Accepted 23 November 2009
- emergency department;
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.