Nebulized Fentanyl in Acute Pain

Thompson, Joshua P.; Thompson, Dennis F.

doi:10.1177/1060028016659077

Cited by 19 publications

(17 citation statements)

References 50 publications

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“…Intranasal fentanyl has been evaluated for immediate pain relief in patients with breakthrough pain. The results have shown that intranasal fentanyl is briskly absorbed by mucosal membranes and reaches maximum concentrations in plasma in approximately 2 min [17]. Nebulized fentanyl, however, is inhaled into the lungs and then absorbed into the blood through circulation via the pulmonary system.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial

Verki

Mozafari

Tirandaz

et al. 2019

African Journal of Emergency Medicine

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IntroductionFentanyl is a lipid soluble, highly potent opioid. The lipid solubility of fentanyl makes it an ideal opioid to be administrated by inhalation. The current study compared ketamine infusion and nebulized fentanyl in bone fracture pain relief.MethodsIn this double-blind, randomized clinical trial, patients aged 18 to 55 years who were admitted to the emergency department (ED) with limb fracture were recruited. A total of 127 patients were included in the study, 51.1% (65) of whom were male and 48.9% (62) of whom were female. The patients were divided equally into two groups: Group I received 100 cm3 IV infusion of normal saline and 4 μg/kg of 50 μg/ml nebulized fentanyl; Group II received 0.4 mg/kg ketamine in 10 min and 5 cm3 nebulized normal saline. Pain was assessed using a visual analog scale just before treatment and 5, 10, 15, 30, and 60 min post-treatment.ResultsBefore intervention, the pain scores of both groups showed no significant difference. However, log linear analysis in both groups showed a significantly decrement during the follow up (60 min) (p < 0.0001). Multiple comparison analysis showed that pain scores were significantly higher in the patients of Group I. Moreover, patients in Group I required additional treatment.ConclusionKetamine can be used as an alternative non-invasive treatment to successfully relieve pain in patients with limb fractures.

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Section: Discussionmentioning

confidence: 99%

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial

Verki

Mozafari

Tirandaz

et al. 2019

African Journal of Emergency Medicine

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“…A variety of fentanyl delivery routes are available as safe alternatives when IV access cannot be obtained. Research has shown 1.5 to 3.0 mcg/kg nebulized fentanyl as effective as IV fentanyl for acute abdominal and musculoskeletal pain in the emergency setting 114 . Research comparing 2 mcg/kg nebulized fentanyl to 0.1 mg/kg IV morphine showed more rapid pain relief, higher patient and physician satisfaction, and similar rates of adverse effects when using fentanyl for acute abdominal pain 1 15 .…”

Section: Opioid Receptor Agonists: Morphine Oxycodone/hydrocodone Fmentioning

confidence: 99%

Essential pharmacologic options for acute pain management in the emergency setting

Cisewski

Motov

2019

Turkish Journal of Emergency Medicine

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Pain is the root cause for the overwhelming majority of emergency department (ED) visits worldwide. However, pain is often undertreated due to inappropriate analgesic dosing and ineffective utilization of available analgesics. It is essential for emergency providers to understand the analgesic armamentarium at their disposal and how it can be used safely and effectively to treat pain of every proportion within the emergency setting. A ‘balanced analgesia’ regimen may be used to treat pain while reducing the overall pharmacologic side effect profile of the combined analgesics. Channels-Enzymes-Receptors Targeted Analgesia (CERTA) is a multimodal analgesic strategy incorporating balanced analgesia by shifting from a system-based to a mechanistic-based approach to pain management that targets the physiologic pathways involved in pain signaling transmission. Targeting individual pain pathways allows for a variety of reduced-dose pharmacologic options – both opioid and non-opioid – to be used in a stepwise progression of analgesic strength as pain advances up the severity scale. By developing a familiarity with the various analgesic options at their disposal, emergency providers may formulate safe, effective, balanced analgesic combinations unique to each emergency pain presentation.

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“…It also results in less painful methods of analgesic delivery, minimizes analgesic toxicity and side effects (for example-opioids), and improves overall management of a variety of painful conditions in the ED. 6 Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York Nebulized administration of ketamine has been studied in the areas of palliative care, therapy for asthma, and acute postoperative management of sore throat. [7][8][9] To our knowledge, there is no literature regarding analgesic efficacy and safety of nebulized ketamine's role in managing acute painful conditions in the ED.The following cases describe five patients presenting to the ED of a tertiary medical center between May-June 2019 with acute painful conditions and receiving nebulized ketamine at three different dosing regimens of 0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg via breathactuated nebulizer.…”

Section: Introductionmentioning

confidence: 99%

Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series

Drapkin

Masoudi

Butt

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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Ketamine administration in sub-dissociative doses in the emergency department (ED) results in effective pain relief in patients with acute traumatic and non-traumatic pain, chronic pain, and opioid-tolerant pain. This case series describes five adult ED patients who received nebulized ketamine for predominantly acute traumatic pain. Three patients received nebulized ketamine at 1.5 milligrams per kilogram (mg /kg) dose, one patient at 0.75 mg/kg, and one patient at 1 mg/kg. All five patients experienced a decrease in pain from the baseline up to 120 minutes. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED.

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Nebulized Fentanyl in Acute Pain

Cited by 19 publications

References 50 publications

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial

Essential pharmacologic options for acute pain management in the emergency setting

Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series

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