title: A randomized controlled trial comparing the effect of intravenous, subcutaneous, and intranasal fentanyl for pain management in patients undergoing cesarean section.
abstract: BACKGROUND
  The objective of this study was to evaluate and compare the effects of three methods of using intravenous (IV), subcutaneous and intranasal (IN) fentanyl for pain management following general anesthesia in patients undergoing cesarean section.
  
  
  METHODS
  A prospective, randomized, single-blind clinical trial was done on 75 patients aged 20-40 years, American Society of Anesthesiology-1, who had a normal singleton pregnancy beyond 36 weeks of gestational age. Patients were randomized to receive 50 μg fentanyl intravenously (Group 1), subcutaneously (Group 2) or intranasally (Group 3) after closure of incision. The pain intensity, nausea, the systolic, and diastolic blood pressures were assessed.
  
  
  RESULTS
  All groups were equivalent for baseline characteristics. The average pain visual analog scale (VAS) score was less in the second group who received fentanyl subcutaneously at the time of recovery admission (6.8 ± 1.5) (P= 0.037) and after 3 h (6.36 ± 1.5) (P= 0.033) postoperatively. The mean VAS score of nausea and the mean systolic and diastolic blood pressures were not significantly different between three groups throughout the study (P> 0.05).
  
  
  CONCLUSIONS
  subcutaneous fentanyl is an effective alternative to IV and IN route of administration for pain management.
authors.affiliation: Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Jabalameli
authors.affiliation: Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Reihanak
authors.initials: R
authors.lastname: Talakoub
authors.affiliation: Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Bita
authors.initials: B
authors.lastname: Abedi
authors.affiliation: Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ghofrani
keywords: Fentanyl; intranasal; intravenous; subcutaneous; visual analog scale