An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints

Abstract

PurposeThe purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures.Patients and methodsThis cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg) administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings.ResultsNo adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment.ConclusionPreliminary evidence indicates that intranasal fentanyl is safe and effective for lumbar facet radiofrequency ablation procedures. Future rigorous randomized control trials are needed to confirm the present results and to examine the effects of intranasal fentanyl on intraoperative and postoperative opioid use.

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

“…The POSS provides guidance for clinical decision making with interventions or actions that can be taken by clinicians in response to concerning levels of sedation. Reliability and validity have been established for the POSS for use on general care units in monitoring patients receiving opioid analgesics (Bartoszek et al, 2017;Cooper, Stannard, & Noble, 2015;Davis et al, 2017;Kobelt et al, 2014;Nisbet & Mooney-Cotter, 2009;Quinlan-Colwell, Thear, Miller-Baldwin, & Smith, 2017;Savelloni et al, 2017). Validated and standardized sedation scales or measures should be incorporated in routine monitoring of patients receiving opioids to guide critical thinking skills and informed decisions about managing pain, sedation, and patient safety.…”