Inhaled fentanyl as a method of analgesia

Abstract

SummaryA study was undgrtaken to investigate the use of fentanyl by aerosol for postoperative analgesia. Seven patients hadplacebo, six received fentanyl 100 pg and seven were given fentanyl300 pg. A Key wordsAnalgesics, narcotic; fentanyl. Aerosols.A simple method of analgesia which is rapidly effective with the minimum of complex apparatus would be useful for the postoperative patient and for self administration by those suffering severe pain at home. Such systems were developed with infusion pumps, but their widespread use is limited by cost and complexity. Delivery of drugs by aerosol into the respiratory tract is simple and has become widely accepted for the prophylaxis and treatment of asthma, in migraine and in angina pectoris. Modern nebulisers, using hospital compressed gases, or electrically driven air nebulisers, are capable of reliably producing aerosols of fine particle size which penetrate the bronchial tree and are deposited in airways and alveoli.'.2 Drug is deposited in sites drained by both the bronchial and pulmonary circulations, and will enter the systemic circulation and reach the brain. There is recent interest in the administration of morphine in this way. '-5 Fentanyl is a synthetic narcotic analgesic which is highly lipid soluble, has a rapid onset of action, is potent, does not release histamine, and which, in a single dose, has a short duration of action. It is an effective analgesic agent for pain relief. We have therefore undertaken a pilot study to look at the use of nebulised fentanyl as a method of postoperative analgesia. MethodsThirty patients in a single-blind study were randomly allocated to receive a standard volume (6 ml) that contained placebo (0.9% saline), 100 p g or 300 pg fentanyl given by nebuliser. Patients were aged 18-65 years, were ASA 1-2, and undergoing a variety of elective surgical procedures (Table 1). Those with known respiratory or hepatic disease, or who were receiving drugs known to interfere with drug metabolism were not studied. Ten patients were allocated to each group. Ethics committee approval and informed written consent were obtained.Premedication consisted of morphine and cyclizine. Anaesthesia was induced with thiopentone and maintained with nitrous oxide and halothane in oxygen. Additional analgesia was provided with morphine, and muscle relaxants were used where indicated.Patients who complained of pain in the recovery room were asked to assess its severity on a 10-cm linear visual analogue (LVA) scale which had been explained the day before. Fentanyl or placebo was then administered in a single-blind fashion via an Acorn I1 nebuliser driven by compressed oxygen and nebulised to dryness in oxygen at a flow of 8-10 litres/ minute to produce a particle size of 2 p

Inhaled nebulised fentanyl for postoperative analgesia

“…They also rated their analgesia as 'none' (0), 'a little' (l), 'moderate' (2), 'almost complete' (3) or 'complete' (4). The patients had been introduced to these scales on the previous day.…”

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

“…74 However, there have been reported side effects related specifically to the IN or inhaled route, including a bitter, burning taste, stinging in the nose, coughing, and nasal pruritus. 65,69,75,76 While evidence suggests that PCINA is efficacious, safe, noninvasive, and easy to administer, there have been only a limited number of randomized, placebo-controlled trials evaluating this route of analgesic administration. Although further research may address these problems, some authors have suggested that IN administration of opioids for postoperative pain relief is not likely to supersede other techniques, but rather play a role in the management of acute pain in children and patients for whom IV access is difficult.…”

Palliative therapy in the terminal stage of neurological disease

“…Opioids may also be used in the therapy of nonmalignant pain [79]. Myths about the use of opiates have been disproven by the hospice work: morphine intolerance is uncommon; addiction or persistent mental clouding is not a problem; respiratory depression does not occur if used for analgesia; oral application is easy; other strong opioids are not necessarily better than morphine; morphine is not always the best pain therapy; and morphine is not only a drug for dying patients [93,101]. There are several forms of opioid administration which have to be considered in the individual patient [30].…”

“…As a last resort, intraspinal analgesic administration is a safe method [45,47]. Headache due to raised intracranial pressure is frequent in terminal neurology patients; however, there is no published therapy recommendation, such as for tumor pain [4,101]. If steroids or other antiedematous therapy is not sufficient, non-steriodal antiphlogistic drugs may be tried, as well as an opiate, titrated in dose against the effect.…”