Intranasal Fentanyl versus Subcutaneous Fentanyl for Pain Management in Prehospital Patients with Acute Pain: A Retrospective Analysis

Tanguay, Alain; J, Lebon; Hébert, Denise; Bégin, François

doi:10.1080/10903127.2019.1704323

Cited by 8 publications

(13 citation statements)

References 38 publications

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…One RS reported a higher proportion of patients with clinically significant pain relief in patients treated with INF than with subcutaneous fentanyl, with no differences in time to drug administration [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

“…In this study, patients aged >70 years received an INF dose of 50 µg, with a rescue dose of 25 µg after 15 min in case of ineffective analgesia. The time of fentanyl administration was similar for both routes of administration (INF, mean 9 min 36 s (s) (SD 3 min 32 s); SCF, mean 9 min 30 s (SD 3 min 46 s), p -value 0.674) [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

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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

Serra

Spampinato

Riccardi³

et al. 2023

JCM

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This systematic review examined the efficacy and safety of intranasal fentanyl (INF) for acute pain treatment in children, adults, and the elderly in prehospital emergency services (PHES) and emergency departments (ED). ClinicalTrials.gov, LILACS, PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane databases were consulted until 31 December 2022. A total of 23 studies were included: 18 in children (1 PHES, 17 ED), 5 in adults (1 PHES, 4 ED) and 1 in older people (1 PHES subgroup analysis). In children, INF was effective in both settings and as effective as the comparator drugs, with no differences in adverse events (AEs); one randomised controlled trial (RCT) showed that INF was more effective than the comparator drugs. In adults, one study demonstrated the efficacy of INF in the PHES setting, one study demonstrated the efficacy of INF in the ED setting, two RCTs showed INF to be less effective than the comparator drugs and one RCT showed INF to be as effective as the comparator, with no difference in AEs reported. In older people, one study showed effective pain relief and no AEs. In summary, INF appears to be effective and safe in children and adults in PHES and ED. More high-quality studies are needed, especially in PHES and older people.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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

Serra

Spampinato

Riccardi³

et al. 2023

JCM

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“…This practice reduces the need for extended observation and monitoring of the child and allows for more rapid discharge if the procedure is performed on an outpatient basis. The use of intranasal naloxone can obviously be used to reverse other opioids in similar settings (eg, prehospital use of intranasal fentanyl), but then, the timing needs to be adapted to the pharmacokinetics of the opioid used 18 …”

Section: Discussionmentioning

confidence: 99%

“…The use of intranasal naloxone can obviously be used to reverse other opioids in similar settings (eg, prehospital use of intranasal fentanyl), but then, the timing needs to be adapted to the pharmacokinetics of the opioid used. 18…”

Section: Study Limitationsmentioning

confidence: 99%

Rapid systemic uptake of naloxone after intranasal administration in children

Olsson

Lönnqvist

Stiller

et al. 2021

Pediatric Anesthesia

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Background: Naloxone has a high affinity for the µ-opioid receptor and acts as a competitive antagonist, thus reversing the effects of opioids. Naloxone is often administrated intravenously, but there is a growing interest in the intranasal route in treating patients with opioid overdose, and in reversing effects after therapeutic use of opioids. As administration is painless and no intravenous access is needed, the intranasal route is especially useful in children. Aim:The aim of this study was to investigate the uptake of naloxone 0.4 mg/ml during the first 20 min after administration as a nasal spray in a pediatric population, with special focus on the time to achieve maximum plasma concentration.Methods: Twenty children, 6 months-10 years, were included in the study. The naloxone dose administered was 20 µg/kg, maximum 0.4 mg, divided into repeated doses of 0.1 ml in each nostril. Venous blood samples were collected at 5, 10, and 20 min after the end of administration.Results: All patients had quantifiable concentrations of naloxone in venous blood at 5 min, and within 20 min, peak concentration had been reached in more than half of the children. At 20 min after intranasal administration, the plasma naloxone concentrations were within the range of 2-6 nanogram/ml. Conclusion:This study confirms the clinical experience that the rapid effect of naloxone after intranasal administration in children was reflected in rapid systemic uptake to achieve higher peak plasma concentrations than previously reported in adults.

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Paramedic insertion of peripheral intravenous catheters, unused catheter rates, and influencing factors: A retrospective review

Golling¹,

Barr²,

Mortel³

et al. 2023

American Journal of Infection Control

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Intranasal Fentanyl versus Subcutaneous Fentanyl for Pain Management in Prehospital Patients with Acute Pain: A Retrospective Analysis

Cited by 8 publications

References 38 publications

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

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

Rapid systemic uptake of naloxone after intranasal administration in children

Paramedic insertion of peripheral intravenous catheters, unused catheter rates, and influencing factors: A retrospective review

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