Effectiveness of transnasal butorphanol for the treatment of musculoskeletal pain

Nasal administration of opioids for pain management in adults

“…Nasal butorphanol (1 mg plus 0.5–1 mg every 30 min, to a maximum of 3 mg in 2 h) was provided in emergency room treatment of acute musculoskeletal pain in 28 patients in an uncontrolled open study (74). Nasal butorphanol displayed rapid onset of 5–15 min, reasonable clinical effect (70–80% had pain reduced by 50% within 60–90 min by doses of 1–3 mg) at an acceptable adverse effect cost (for instance drowsiness in 80% – nausea in 11%, and four patients (14%) complained about nasal irritation)).…”

“…Direct nasal effects are more of a potential concern. Short‐term usage (less than 3 days) did not lead to serious nasal sequela, however, 14% of 28 patients (74) and 8% of 107 patients (82) reported nasal irritation. Long‐term use (duration not specified) was associated with nasal congestion in 13% of patients, and with epistaxis, nasal irritation, rhinitis, pharyngitis, upper respiratory infection and sinus congestion in 3–9% of patients (52).…”

“…Design: Approximately 50% of the reviewed studies were open and uncontrolled, thus limiting their value as instruments for clinical decision making (68, 71, 73–76). Except for the study on nasal diamorphine in children (69), none of the randomized, controlled studies reviewed in this report (33, 56, 59, 61–67, 70) fulfills the criteria of the CONSORT (Consolidated Standards of Reporting Trials) statement (81).…”

Review on pharmacological pain management in trauma patients in (pre‐hospital) emergency medicine in the Netherlands

“…The excluded analgesics were NSAIDs [ketorolac (Wright et al, 1994;Turturro et al, 1995;Neighbor and Puntillo, 1998;Rainer et al, 2000), mefenamic acid (Stableforth, 1977;Sleet and Khan, 1980), diflunisal (Aghababian, 1986) and piroxicam (Morán, 1990)], opioids [nalbuphine (Stene et al, 1988;Chambers and Guly, 1994;Hyland-McGuire and Guly, 1998;Woollard et al, 2002Woollard et al, , 2004, hydrocodone (Marco et al, 2005) and butorphanol (Scott et al, 1994)] and a type of paracetamol [hydrocodoneacetaminophen (Turturro et al, 1998)]. This may have led to the loss of relevant information for emergency care settings in other countries.…”

Noninvasive drug delivery

“…Others have found nasal butorphanol effective after cesarean section, 61 episiotomy, 63 orthopedic surgeriesy in children, 64 and in the emergency department. 65 Other Intranasal Opioids. Many clinicians and researchers have administered a variety of opioids by the nasal route.…”