title: Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study.
abstract: BACKGROUND
  Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions.
  
  
  METHODS
  We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation. Facial Pain Scale Revised (FPS-R) and Face, Leg, Activity, Cry, Consolability (FLACC) scores were used to evaluate pain and anxiety before, during and after procedure. University of Michigan Sedation Score (UMSS), adverse events, detailed side effects and satisfaction of patients, parents and medical staff were recorded at discharge. A follow up telephone call was made after 24-72h.
  
  
  RESULTS
  90 patients were included. There was no difference in FPS-R during the procedure (median score 2 versus 2), but the FLACC score was significantly higher as compared to before (median score 4 versus 0, Δ 2, 95% CI 0, 2). Median UMSS was 1 (95% CI 1, 2). We recorded no serious adverse events. Rate of vomiting was 12% (11/84). Satisfaction was high among participants responding to this question 85/88 (97%) of parents, 74/83 (89%) of patients and 82/85 (96%) of physicians would want the same sedation again.
  
  
  CONCLUSIONS
  PSA with IN fentanyl and N2O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada. Electronic address: julia.hoeffe@insel.ch.
authors.forename: J
authors.initials: J
authors.lastname: Hoeffe
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Doyon Trottier
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Bailey
authors.affiliation: Emergency Department, Royal Children's Hospital, University of Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Shellshear
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Lagacé
authors.affiliation: Emergency Department, Royal Children's Hospital, University of Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Sutter
authors.affiliation: Division of Orthopedics, Department of Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Grimard
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Cook
authors.affiliation: Emergency Department, Royal Children's Hospital, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; University of Melbourne, Australia.
authors.forename: F E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D000698:Analgesia; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001007:Anxiety / Q000188:drug therapy; D001315:Australia; D002170:Canada; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D009609:Nitrous Oxide / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide; D005283:Fentanyl