Randomized Trial of Intranasal Fentanyl Versus Intravenous Morphine for Abscess Incision and Drainage

Fenster, Daniel; Dayan, Peter; Babineau, John; Aponte-Patel, Linda; Tsze, Daniel S

doi:10.1097/pec.0000000000000810

Cited by 19 publications

(19 citation statements)

References 24 publications

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“…To determine non-inferiority of coadministered compared with preadministered lidocaine, we used a predetermined margin of non-inferiority (Δ) of 1.80 (SD 2.25). This margin was based on pooling effect estimates from previous randomized clinical trials of children undergoing painful procedures and selecting an estimate that represented a clinically significant difference [14][15][16][17][18]. To demonstrate non-inferiority with this Δ with a 1-tailed α of .025 and power of 80%, we required 25 patients in each arm, for a total of 50 patients.…”

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confidence: 99%

Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial

et al. 2020

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confidence: 99%

Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial

et al. 2020

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“…This review was performed based on those eight articles. [35][36][37][38][39][40][41][42] Included studies were published between 1999 and 2018, and were conducted in Australia (n=4), United State (n=2), and the United Kingdom (n=2). All included studies contained two comparison arms.…”

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confidence: 99%

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

Aleysae

2019

Emerg Care J

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In recent years, the nasal route has increasingly been viewed as an alternative option for the delivery of analgesia, especially when the traditional ways are complicated or time-intensive. However, little is known about the value of this intervention in acute pain management in pediatric emergency medicine. This evidence-based analysis review aims to assess the current evidence regarding the use, safety, and effectiveness of intranasal analgesics in acutely painful conditions encountered in Pediatric Emergency Departments (PEDs). A systemic electronic searching of Cochrane library, PubMed, and EMBASE databases from the beginning of each database until October 2018 was conducted using a maximally sensitive searching strategy. Only randomized controlled trials (RCTs) or quasirandomized controlled trials that evaluated the use of intranasal analgesia for acute pain in children in the Emergency Department and published between January 1990 and October 2018 were included. The methodological quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Risks of bias within each included study were evaluated according to the Cochrane Risk of Bias Tool for RCTs. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. Seven RCTs and one quasi-randomized study met the inclusion criteria. Five studies compared an intranasal analgesic and an alternative intervention, two compared intranasal fentanyl against ketamine, and one compared two different concentrations of intranasal fentanyl. All included trials reported reductions in pain scores, especially within the first 10 to 30 minutes post-intervention; however, pain reduction was maintained to 60 minutes in only one study. No evidence of significant adverse events was associated with the administration of any intranasal analgesic in any of the included studies. This review identified eight articles that discussed the intranasal analgesia as a possible route of analgesia in the PED. While no paper was entirely perfect, the findings support the idea that intranasal analgesia may be an effective analgesic for the treatment of children (3-18 years) with acute moderate to severe pain, and its administration appears to cause minimal adverse effects.

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“…Intranasal fentanyl provided similar levels of behavioral distress and reduced pain levels after abscess incision and drainage procedures of children compared with those receiving intravenous morphine. 12 Similarly, a Cochrane review of pediatric trials indicated that intranasal fentanyl is likely effective for acute moderate-to-severe pain. 13 In addition to evidence indicating efficacy and tolerability of intranasal fentanyl in children, additional research has cited similar effects in adults.…”

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confidence: 99%

An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints

Bartoszek

McCoart

Hong

et al. 2017

JPR

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PurposeThe purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures.Patients and methodsThis cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg) administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings.ResultsNo adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment.ConclusionPreliminary evidence indicates that intranasal fentanyl is safe and effective for lumbar facet radiofrequency ablation procedures. Future rigorous randomized control trials are needed to confirm the present results and to examine the effects of intranasal fentanyl on intraoperative and postoperative opioid use.

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Randomized Trial of Intranasal Fentanyl Versus Intravenous Morphine for Abscess Incision and Drainage

Abstract: In a small sample of children aged 4 to 18 years undergoing abscess I&D, IN fentanyl was noninferior, and potentially superior, to IV morphine for reducing procedural pain and distress.

Cited by 19 publications

References 24 publications

Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial

Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial

Is the nasal route a viable option for relieving acute pain in pediatric emergency medicine? A literature review

An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints

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