Intranasal fentanyl titration for postoperative pain management in an unselected population

TLDR

The study evaluated whether intranasal fentanyl is suitable for postoperative pain control in routine, unselected patients. In a double‑blind RCT, 112 patients received 0.027 mg fentanyl either intranasally or intravenously, with doses repeated every 5 min until pain relief, and pain was assessed at regular intervals up to 80 min. Intranasal fentanyl achieved adequate pain relief in 52 of 53 patients, with pain scores dropping markedly within 5 min; although IV dosing produced slightly lower pain scores at 10–20 min, side‑effect rates were low and intranasal administration proved effective.

Abstract

Summary A randomised, double‐blind study was undertaken to investigate the suitability of intranasally administered fentanyl for postoperative pain management under routine conditions in an unselected population. For postoperative pain relief, patients received either 0.027 mg fentanyl intranasally and sodium chloride 0.9% intravenously (intranasal group, n = 53) or sodium chloride 0.9% intranasally and 0.027 mg fentanyl intravenously (intravenous group, n = 59). These doses were repeated every 5 min until the patients were free of pain or refused further analgesia. Pain severity was evaluated before beginning opioid titration and 5, 10, 15, 20, 30, 40, 50, 60, 70 and 80 min thereafter. Adequate pain relief was achieved in 52 of 53 patients in the intranasal and in all patients in the intravenous group. Pain intensities evaluated on a 101‐point numerical rating scale as well as on a verbal rating scale decreased significantly in both study groups within 5 min. At the 15 min measurement point, numerical rating scale pain intensity and at the 10 and 20 min point, verbal rating scale pain intensity was significantly lower in the intravenous group. The incidence of side effects was low in both groups and no patient complained of intranasal pain. Intranasally administered fentanyl would appear to be suitable for the management of postoperative pain.