Oral transmucosal fentanyl citrate versus placebo for painful dressing changes: a crossover trial.
OBJECTIVE
Fentanyl is a potent opioid that is well absorbed via the oral mucosa. It can be given as an oral lozenge. The onset of analgesia is rapid and matches the pain profile observed at dressing changes.


METHODS
Patients experiencing pain during daily dressing changes were given entonox plus either placebo or oral transmucosal fentanyl citrate (OTFC) for two consecutive dressing changes in a randomised double-blind placebo-controlled crossover trial.


RESULTS
Nine patients were recruited. The mean worst pain score during dressing changes was 7/10 with placebo and 4/10 with OTFC; the reduction in pain achieved with OTFC was significant. The mean number of breaths of entonox taken during the dressing change was 27.67 with placebo and 4.67 with OTFC; the reduction in the number of entonox breaths with OTFC was significant. One patient in the OTFC group suffered nausea.


CONCLUSIONS
Compared with placebo, OTFC improved analgesia during painful dressing changes without an increase in side-effects.
MacIntyre
P A
PA
Royal Devon and Exeter Hospital, Exeter, UK. jamac@doctors.org.uk
Margetts
L
L
Larsen
D
D
Barker
L
L
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000378:metabolism / Q000627:therapeutic use*; D019162:Anesthetics, Combined / Q000627:therapeutic use; D001458:Bandages / Q000009:adverse effects*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000378:metabolism / Q000627:therapeutic use*; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa; D009609:Nitrous Oxide / Q000627:therapeutic use; D010100:Oxygen / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D010147:Pain Measurement; D012720:Severity of Illness Index; D017592:Skin Care / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; C001147:Entonox; D009609:Nitrous Oxide; D010100:Oxygen; D005283:Fentanyl