title: Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial.
abstract: Patients with acute abdominal pain commonly present to emergency departments. The safe and effective relief of discomfort is a concern to patients and physicians. Intravenous opioids are the traditional method used to provide pain relief in this setting, but intravenous access is time consuming and not always achievable. Alternative methods of pain control may therefore be necessary for the acute management of painful conditions without adding to the overall physical or psychological discomfort. The purpose of this study was to evaluate the feasibility of nebulized fentanyl (NF) in the alleviation of acute and undifferentiated abdominal pain. We also sought to compare NF with intravenous morphine (IVM) and to assess patient and provider satisfaction with NF. Nebulized fentanyl (2 μg/kg) was compared to IVM (0.1 mg/kg) at 10, 20, 30, and 40 minutes; and patient and physician satisfaction was recorded. The NF group experienced more rapid pain relief and more sustained and clinically significant pain relief over the 40-minute study interval. There were no adverse effects noted in the NF group. Both patient and physician satisfaction scores were higher in the NF group. Fentanyl citrate at a dose of 2 μg/kg through a breath-actuated nebulizer appears to be a feasible and safe alternative to IVM (0.1 mg/kg) in the treatment of acute abdominal pain.
authors.affiliation: Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Drive, San Diego, CA 92134. Electronic address: travis.deaton@gmail.com.
authors.forename: Travis
authors.initials: T
authors.lastname: Deaton
authors.affiliation: Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Drive, San Diego, CA 92134. Electronic address: jdauten@gmail.com.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Auten
authors.affiliation: University of California, San Francisco (UCSF), Fresno Medical Education Program, Department of Emergency Medicine, 155 N Fresno St, Fresno CA 93701. Electronic address: mike.darracq@gmail.com.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Darracq
mesh_terms: D000006:Abdomen, Acute / Q000188:drug therapy*; D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010919:Placebos
chemical_list: D000701:Analgesics, Opioid; D010919:Placebos; D009020:Morphine; D005283:Fentanyl