A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting.
OBJECTIVE
The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia.


METHODS
This was a randomized, controlled, open-label trial. Consecutive adult patients (n = 258) requiring analgesia (Verbal Rating Score [VRS] >2/10 noncardiac or >5/10 cardiac) were recruited. Patients received INF 180 mug +/- 2 doses of 60 mug at > or =5-minute intervals or IVM 2.5 to 5 mg +/- 2 doses of 2.5 to 5 mg at > or =5-minute intervals. The end point was the difference in baseline/destination VRS.


RESULTS
Groups were equivalent (P = not significant) for baseline VRS [mean (SD): INF 8.3 (1.7), IVM 8.1 (1.6)] and minutes to destination [mean (SD): INF 27.2 (15.5), IVM 30.6 (19.1)]. Patients had a mean (95% confidence interval) VRS reduction as follows: INF 4.22 (3.74-4.71), IVM 3.57 (3.10-4.03); P = .08. Higher baseline VRS (P < .001), no methoxyflurane use (P < .01), and back pain (P = .02) predicted VRS reduction. Safety and acceptability were comparable.


CONCLUSIONS
There was no significant difference in the effectiveness of INF and IVM for prehospital analgesia.
Rickard
Claire
C
Research Centre for Practice Innovation, Griffith University, Nathan, Queensland 4111, Australia. rickard_claire@yahoo.com.au
O'Meara
Peter
P
McGrail
Matthew
M
Garner
David
D
McLean
Alan
A
Le Lievre
Peter
P
D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004632:Emergency Medical Services; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D012044:Regression Analysis
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl