title: An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints.
abstract: OBJECTIVE
  The purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures.
  
  
  METHODS
  This cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg) administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings.
  
  
  RESULTS
  No adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment.
  
  
  CONCLUSIONS
  Preliminary evidence indicates that intranasal fentanyl is safe and effective for lumbar facet radiofrequency ablation procedures. Future rigorous randomized control trials are needed to confirm the present results and to examine the effects of intranasal fentanyl on intraoperative and postoperative opioid use.
authors.affiliation: Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, NC.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bartoszek
authors.affiliation: Clinical Investigations, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, NC.
authors.forename: Amy
authors.initials: A
authors.lastname: McCoart
authors.affiliation: Research Department, The Center for Clinical Research, Sceptor Pain Foundation, Winston Salem, NC.
authors.forename: Kyung-Soo Jason
authors.initials: KJ
authors.lastname: Hong
authors.affiliation: Clinical Investigations, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, NC.
authors.forename: Chelsey
authors.initials: C
authors.lastname: Haley
authors.affiliation: Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Uniformed Services University, Bethesda, MD, USA.
authors.forename: Krista Beth
authors.initials: KB
authors.lastname: Highland
authors.affiliation: Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, NC.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Plunkett
keywords: analgesia; chronic pain; sedation; spinal procedures