An open-label randomised controlled trial on the efficacy of adding intranasal fentanyl to intravenous tramadol in patients with moderate to severe pain following acute musculoskeletal injuries

Chew, Keng Sheng; Shaharudin, Abdul Hafiz

doi:10.11622/smedj.2016096

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…Seven of the 72 included studies [ 56 , 59 , 60 , 62 , 71 , 80 , 87 ] were scored at a high overall risk of bias (eTable 3); all investigated opioid-related adverse events. More than one-third of included studies (25 studies) [ 35 , 36 , 45 , 47 , 51 , 53 , 56 , 57 , 59 , 62 , 63 , 67 , 71 , 73 , 75 , 77 , 80 , 85 , 87 , 88 , 90 , 92 , 94 , 95 , 101 ] were considered as having high or unsure risk of attribution bias due to the lack of reporting of loss to follow-up in randomised controlled trials or data completion rate not reported in observational studies.…”

Section: Resultsmentioning

confidence: 99%

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

Chen,

Maher,

Han

et al. 2023

Drugs

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Background The prevalence of continued opioid use or serious adverse events (SAEs) following opioid therapy in the emergency department (ED) for musculoskeletal pain is unclear. The aim of this review was to examine the prevalence of continued opioid use and serious adverse events (SAEs) following the provision of opioids for musculoskeletal pain in the emergency department (ED) or at discharge. Methods Records were searched from MEDLINE, EMBASE and CINAHL from inception to 7 October 2022. We included randomised controlled trials and observational studies enrolling adult patients with musculoskeletal pain who were administered and/or prescribed opioids in the ED. Continued opioid use and opioid misuse data after day 4 since ED discharge were extracted. Adverse events were coded using the Common Terminology Criteria for Adverse Events (CTCAE), and those rated as grades 3–4 (severe or life-threatening) and grade 5 (death) were considered SAEs. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Seventy-two studies were included. Among opioid-naïve patients who received an opioid prescription, 6.8–7.0% reported recent opioid use at 3–12 months after discharge, 4.4% filled ≥ 5 opioid prescriptions and 3.1% filled > 90-day supply of opioids within 6 months. The prevalence of SAEs was 0.02% [95% confidence interval (CI) 0, 0.2%] in the ED and 0.1% (95% CI 0, 1.5%) within 2 days. One study observed 42.9% of patients misused opioids within 30 days after discharge. Conclusions Around 7% of opioid-naïve patients with musculoskeletal pain receiving opioid therapy continue opioid use at 3–12 months after ED discharge. SAEs following ED administration of an opioid were uncommon; however, studies only monitored patients for 2 days. Protocol Registration 10.31219/osf.io/w4z3u. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-023-01941-1.

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Section: Resultsmentioning

confidence: 99%

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

Chen,

Maher,

Han

et al. 2023

Drugs

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“…A total of 19,720 were retrieved from PubMed (n = 3,577), Embase (n = 5,113), Cochrane Library (n = 8,024), and Web of Science (n = 3,006). After deleting duplicates (n = 7,891), and excluding ineligible studies based on titles and abstracts (n = 11,698) and on full texts (n = 111), 20 studies ( Turturro et al, 1998 ; Vergnion et al, 2001 ; Miller and Ernst, 2004 ; Soysal et al, 2004 ; Marco et al, 2005 ; Hewitt et al, 2007 ; Bounes et al, 2010 ; Shear et al, 2010 ; Jalili et al, 2012 ; Smith et al, 2012 ; Wenderoth et al, 2013 ; Shervin et al, 2014 ; Zare et al, 2014 ; Chang et al, 2017 ; Chew and Shaharudin, 2017 ; Eizadi et al, 2018 ; Pan et al, 2018 ; Blancher et al, 2019 ; Vahedi et al, 2019 ; Bijur et al, 2021 ) of 3,040 patients were eventually included in this network meta-analysis. Figure 1 shows the flow chart of study screening.…”

Section: Resultsmentioning

confidence: 99%

“…Vahedi et al ( Vahedi et al, 2019 ) found that fentanyl reduced pain faster than morphine, and fewer patients needed rescue analgesia after fentanyl in the emergency setting. Another trial proposed that despite effectiveness, intranasal fentanyl may not be a suitable analgesic choice since it resulted in hypotension and dizziness in patients using fentanyl + tramadol versus those using tramadol only ( Chew and Shaharudin, 2017 ). At present, for patients with traumatic pain in the emergency department, it is still unclear which of these opioid analgesics (in addition to the above opioids) is more effective.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of opioids for traumatic pain in the emergency department: a systematic review and Bayesian network meta-analysis

Fu¹,

Liu²,

Nie³

2023

Front. Pharmacol.

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Aim: To systematically assess and rank the efficacy of opioid medications for traumatic pain in the emergency department in terms of pain relief, adverse events and rescue analgesia.Methods: Four databases were systematically searched until 26 September 2022: PubMed, Embase, Cochrane Library, and Web of Science. Outcomes were pain relief, adverse events (dizziness, hypotension, pruritus, sedation), and rescue analgesia. For each outcome, network plots were drawn to exhibit direct and indirect comparisons, and rank probabilities were utilized to rank the efficacy of different opioids.Results: Twenty studies of 3,040 patients were eligible for this network meta-analysis. According to the rank probabilities, the top three analgesic medications for pain relief may be sufentanil (78.29% probability of ranking first), buprenorphine (48.54% probability of ranking second) and fentanyl (53.25% probability of ranking third); buprenorphine (31.20%), fentanyl (20.14%) and sufentanil (21.55%) were least likely to cause dizziness; the top three analgesic medications which were least likely to cause hypotension were buprenorphine (81.64%), morphine (45.02%) and sufentanil (17.27%); butorphanol (40.56%), morphine (41.11%) and fentanyl (14.63%) were least likely to cause pruritus; the top three medications which were least likely to cause sedation were hydrocodone + acetaminophen (97.92%), morphine (61.85%) and butorphanol (55.24%); patients who received oxycodone (83.64%), butorphanol (38.31%) and fentanyl (25.91%) were least likely to need rescue analgesia in sequence.Conclusion: Sufentanil, buprenorphine and fentanyl may be superior to other opioid medications in terms of pain relief and the incidence of dizziness, hypotension and pruritus, which might be selected as opioid analgesics for traumatic pain in the emergency setting.

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“…Blancher et al (2019) compared IN sufentanil versus IV morphine, assessing NRS at 30 min, with 4 h follow-up: they found some severe respiratory AEs (reporting a number needed to harm = 17), questioning the safety of this medication [14]. Chew et al (2017), in a small open-label study, compared IN fentanyl added to IV tramadol and metoclopramide, showing an improvement in VAS score at 10 min, with transient side effects such as lowering in blood pressure and dizziness [15].…”

Section: Trauma and Injuriesmentioning

confidence: 99%

Effectiveness of Intranasal Analgesia in the Emergency Department

Zanza,

Saglietti,

Giamello

et al. 2023

Medicina

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In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992–2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.

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An open-label randomised controlled trial on the efficacy of adding intranasal fentanyl to intravenous tramadol in patients with moderate to severe pain following acute musculoskeletal injuries

Cited by 9 publications

References 22 publications

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

Continued Opioid Use and Adverse Events Following Provision of Opioids for Musculoskeletal Pain in the Emergency Department: A Systematic Review and Meta-Analysis

Efficacy of opioids for traumatic pain in the emergency department: a systematic review and Bayesian network meta-analysis

Effectiveness of Intranasal Analgesia in the Emergency Department

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