Transbuccal fentanyl for rapid relief of orthopedic pain in the ED.
OBJECTIVE
This study's objectives were to assess administration of a rapidly dissolving transbuccal fentanyl tablet to patients in emergency department (ED) with orthopedic extremity pain. The main end point was time required to achieve a 2-point drop on a 0 to 10 pain scale.


METHODS
In this double-blind trial, subjects received either transbuccal fentanyl, 100 μg, and a swallowed placebo, or a swallowed oxycodone/acetaminophen, 5/325-mg pill, and a nonanalgesic transbuccal comparator. Pain assessment occurred every 5 minutes for an hour, and vital signs were monitored for 2 hours.


RESULTS
Transbuccal fentanyl was associated with faster pain relief onset (median, 10 vs 35 minutes; P < .0001). Secondary end points (pain relief magnitude, rescue medication rate, subject preference for medication on future visit) favored transbuccal fentanyl. No vital sign abnormalities or significant side effects occurred in the ED or on 100% next-day follow-up.


CONCLUSIONS
Transbuccal fentanyl shows promise for continued investigation as a means to safely provide rapid and effective pain relief for ED patients.
Shear
Melissa L
ML
Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA.
Adler
Jonathan N
JN
Shewakramani
Sanjay
S
Ilgen
Jon
J
Soremekun
Olanrewaju A
OA
Nelson
Sara
S
Thomas
Stephen H
SH
D000278:Administration, Buccal; D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000188:drug therapy; D006801:Humans; D004204:Joint Dislocations / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D013997:Time Factors; D014947:Wounds and Injuries / Q000188:drug therapy*
D000701:Analgesics, Opioid; D010098:Oxycodone; D005283:Fentanyl