Dianne Crellin1, Rong Xiu Ling, Franz E Babl. 1. Emergency Department, Royal Children's Hospital,The University of Melbourne, Parkville, VIC 3055, Australia. dianne.crellin@rch.org.au
Abstract
BACKGROUND: Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the ED. A concentrated solution of fentanyl (300 microg/mL) has been used in prior trials, yet many ED use the standard solution at a concentration of 50 microg/mL, which is widely available and of low cost. We set out to determine if this lower concentration of fentanyl is also efficacious. METHODS: Prospective audit in children aged 5-18 years presenting with upper limb injuries. Patients received IN fentanyl (50 microg/mL) at 1.5 microg/kg. Patient assessed pain scores were collected 5, 10, 20, 30 and 60 min following IN fentanyl administration using a visual analogue scale or Bieri Faces-Revised scale. Parental scores were used if patients were unable to provide a score. RESULTS: Of the 59 eligible patients, 36 were enrolled; median age was 6.8 years (range 5-15 years), and 89% (32/36) ultimately required fracture reduction. Median first dose of IN fentanyl was 1.4 microg/kg. Median pain scores dropped from 7 (interquartile range 5-10) pre-fentanyl to 5 (interquartile range 4-8) at 5 min and 2 (interquartile range 1-4) at 30 and 60 min. A total of 21 (58%) children did not require further analgesia in the ED. There were no adverse events. CONCLUSIONS: Standard i.v. concentration IN fentanyl (50 microg/mL) appears to have analgesic efficacy in children with upper limb injuries.
BACKGROUND: Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the ED. A concentrated solution of fentanyl (300 microg/mL) has been used in prior trials, yet many ED use the standard solution at a concentration of 50 microg/mL, which is widely available and of low cost. We set out to determine if this lower concentration of fentanyl is also efficacious. METHODS: Prospective audit in children aged 5-18 years presenting with upper limb injuries. Patients received IN fentanyl (50 microg/mL) at 1.5 microg/kg. Patient assessed pain scores were collected 5, 10, 20, 30 and 60 min following IN fentanyl administration using a visual analogue scale or Bieri Faces-Revised scale. Parental scores were used if patients were unable to provide a score. RESULTS: Of the 59 eligible patients, 36 were enrolled; median age was 6.8 years (range 5-15 years), and 89% (32/36) ultimately required fracture reduction. Median first dose of IN fentanyl was 1.4 microg/kg. Median pain scores dropped from 7 (interquartile range 5-10) pre-fentanyl to 5 (interquartile range 4-8) at 5 min and 2 (interquartile range 1-4) at 30 and 60 min. A total of 21 (58%) children did not require further analgesia in the ED. There were no adverse events. CONCLUSIONS: Standard i.v. concentration IN fentanyl (50 microg/mL) appears to have analgesic efficacy in children with upper limb injuries.
Authors: Daniel S Tsze; Maria Ieni; Daniel B Fenster; John Babineau; Joshua Kriger; Bruce Levin; Peter S Dayan Journal: Ann Emerg Med Date: 2016-11-04 Impact factor: 5.721
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Authors: Andis Graudins; Robert Meek; Diana Egerton-Warburton; Robert Seith; Trentham Furness; Rose Chapman Journal: Trials Date: 2013-07-10 Impact factor: 2.279