title: A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting.
abstract: 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.
authors.affiliation: Research Centre for Practice Innovation, Griffith University, Nathan, Queensland 4111, Australia. rickard_claire@yahoo.com.au
authors.forename: Claire
authors.initials: C
authors.lastname: Rickard
authors.forename: Peter
authors.initials: P
authors.lastname: O'Meara
authors.forename: Matthew
authors.initials: M
authors.lastname: McGrail
authors.forename: David
authors.initials: D
authors.lastname: Garner
authors.forename: Alan
authors.initials: A
authors.lastname: McLean
authors.forename: Peter
authors.initials: P
authors.lastname: Le Lievre
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl