Does intranasal fentanyl provide efficient analgesia for renal colic in adults?

Abstract

IntroductionIntranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics.MethodsA prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patient's presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded.Results23 eligible patientswere enrolled; median age was 51,3years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 μg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded.ConclusionIntranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.

Intranasal Fentanyl for Acute Pain Management in Children, Adults and Elderly Patients in the Prehospital Emergency Service and in the Emergency Department: A Systematic Review

“…Out of 23 studies included, 18 studies were conducted in children: 1 PS in the PHES (Murphy et al, 2017 [ 38 ]), 9 observational studies (Akinsola et al, 2018 [ 39 ], Anderson et al, 2022 [ 40 ], Cole et al, 2009 [ 41 ], Crelin et al, 2010 [ 42 ], Finn et al, 2010 [ 43 ], Kelly et al, 2018 [ 44 ], Nemeth et al, 2019 [ 45 ], Saunders et al, 2010 [ 46 ], Schaefer et al, 2015 [ 47 ]) and 8 RCTs (Borland et al, 2011 [ 48 ], Fein et al, 2017 [ 49 ], Frey et al, 2019 [ 50 ], Graudins et al, 2015 [ 51 ], Quinn et al, 2021 [ 52 ], Reynolds et al, 2017 [ 53 ], Ruffin et al, 2022 [ 54 ], Younge et al, 1999 [ 30 ]) in the ED; 5 studies were conducted in the adult population: 1 observational study in the PHES setting (Tanguay et al, 2020 [ 55 ]), 2 observational studies (Assad et al, 2023 [ 56 ], Belkouch et al, 2015 [ 57 ]) and 2 RCTs (Nasr Isfahani et al, 2022 [ 58 ], Nazemian et al, 2020 [ 59 ]) in the ED setting; one subgroup analysis of an observational study reported data on the elderly patients in the PHES (Tanguay et al, 2020 [ 55 ]). A total of 10,280 patients were included: 1203 in the PHES setting (94 children, 729 adults and 380 elderly) and 9077 in the ED setting (8714 children and 363 adults).…”

“…One PS reported that INF effectively reduced pain at each time point after administration (5, 30, 45 and 60 min) [ 57 ]; one RS reported no difference in pain reduction with IV morphine [ 56 ]; one RCT reported a reduced efficacy at 5 min and 10 min compared with IN ketamine, with no difference at 30 and 40 min [ 58 ]; one RCT reported a reduced efficacy of INF compared with IV fentanyl at each time point after administration [ 59 ]. Regarding secondary efficacy outcomes, one RS reported no difference in time to first analgesic administration between INF and IV morphine.…”

“…In adults, one study in the PHES setting showed INF to be effective, feasible and safe, particularly in older people. Four studies have shown INF to be rapid and effective in the ED setting [ 57 ], equivalent to IV morphine [ 56 ] and IN ketamine [ 58 ], as effective as IV fentanyl at 30 min but less effective at 10, 20 and 60 min [ 59 ]. Despite the very few minor adverse events reported in the included studies, older adults with obstructive sleep apnoea, chronic obstructive pulmonary disease, heart disease and diabetes mellitus may be at a higher risk for adverse respiratory effects [ 60 , 61 ] and further studies focusing on this population are needed.…”

Alteration of Political Belief by Non-invasive Brain Stimulation

“…Such a proposal would lead us to suggest that the specific regulatory process (i.e., enhanced error feedback/cognitive conflict) evoked with transcranial stimulation may have biased the participants in favor of more conservative values and beliefs. Indeed, recent studies in political psychology have begun to document the differential regulatory mechanisms underlying right- and left-wing ideology (Janoff-Bulman et al, 2008 , 2009 ; Janoff-Bulman, 2009 ), with recent fMRI investigations demonstrating a specific relationship between multi-dimensional scales of conservatism and activity of the right DLPFC (e.g., Zamboni et al, 2009 ). Zamboni and colleagues further discuss these findings in terms of a heightened sense of cognitive dissonance between self-interest and fairness that results in more complex social judgments in Conservative individuals.…”

Utilidad de medicamentos intranasales en urgencias

“…Se ha comparado la utilización de fentanilo intravenosa con intranasal para manejo del dolor posoperatorio al igual que en el manejo analgésico de pacientes pediátricos quemados, fractura de huesos largos, y se determinó que la administración intranasal fue rápida y además sin eventos adversos significativos [31], [32]- [36].…”