title: Safety of intranasal fentanyl in the out-of-hospital setting: a prospective observational study.
abstract: OBJECTIVE
  Initial out-of-hospital analgesia is sometimes hampered by difficulties in achieving intravenous access or lack of skills in administering intravenous opioids. We study the safety profile and apparent analgesic effect of intranasal fentanyl in the out-of-hospital setting.
  
  
  METHODS
  In this prospective observational study, we administered intranasal fentanyl in the out-of-hospital setting to adults and children older than 8 years with severe pain resulting from orthopedic conditions, abdominal pain, or acute coronary syndrome refractory to nitroglycerin spray. Patients received 1 to 3 doses of either 50 or 100 μg, and the ambulance crew recorded adverse effects and numeric rating scale (0 to 10) pain scores before and after treatment.
  
  
  RESULTS
  Our 903 evaluable patients received a mean cumulative fentanyl dose of 114 μg (range 50 to 300 μg). There were no serious adverse effects and no use of naloxone. Thirty-six patients (4%) experienced mild adverse effects: mild hypotension, nausea, vomiting, vertigo, abdominal pain, rash, or decrease of Glasgow Coma Scale score to 14. The median reduction in pain score was 3 (interquartile range 2 to 5) after fentanyl administration.
  
  
  CONCLUSIONS
  The out-of-hospital administration of intranasal fentanyl in doses of 50 to 100 μg is safe and appears effective.
authors.affiliation: Department of Anaesthesia 4231, Center of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Anders P
authors.initials: AP
authors.lastname: Karlsen
authors.affiliation: Emergency Medical Services, The Ambulance Company Falck Danmark A/S, Copenhagen, Denmark.
authors.forename: Danny M B
authors.initials: DM
authors.lastname: Pedersen
authors.affiliation: Medical Department, The Ambulance Company Falck Danmark A/S, Copenhagen, Denmark.
authors.forename: Sven
authors.initials: S
authors.lastname: Trautner
authors.affiliation: Department of Anaesthesia 4231, Center of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jørgen B
authors.initials: JB
authors.lastname: Dahl
authors.affiliation: Department of Anaesthesia 4231, Center of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: morten.sejer.hansen@dadlnet.dk.
authors.forename: Morten S
authors.initials: MS
authors.lastname: Hansen
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D054058:Acute Coronary Syndrome / Q000188:drug therapy; D059787:Acute Pain / Q000188:drug therapy; D000281:Administration, Intranasal / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl