Intranasal fentanyl has been shown to be a safe, effective mode of analgesic administration in prehospital, emergency department, and postoperative patients. We evaluated the use of intranasal fentanyl for initial analgesia in injured patients at a ski resort.
Methods
We retrospectively reviewed the charts of 46 injured adult and pediatric patients treated with intranasal fentanyl during the 2007–2008 winter ski season. Patients were treated with fentanyl according to online MCEP-approved doses (approximate dose 1.4 μg/kg), using 50 μg/mL concentration fentanyl administered with a MAD Nasal (Wolfe Tory Medical Inc, Salt Lake City, UT) mucosal atomizing device. Doses were administered in 1/6 dose increments in alternating nares. Pain scores were recorded at 0, 2, 5, and 10 minutes using a verbally administered numerical rating scale of 0 through 10.
Results
Data analysis was performed using results from 42 of the 46 patients: 5 pediatric and 37 adult. Four patients were excluded due to incomplete data. Thirty-four patients were initially treated on-slope and 8 patients were initially treated in the clinic. Average weight-based dosage for intranasal fentanyl was 1.4 μg/kg (95% confidence interval [CI]: 1.3–1.5 μg/kg; n = 42). The mean baseline pain score for all patients was 8.2 (95% CI: 7.7–8.7; n = 42). Pain scores were significantly reduced after treatment with fentanyl. Mean pain score reduction at 2 minutes was −1.4 (95% CI: −2.0 to −0.96; n = 41); at 5 minutes, −2.8 (95% CI: −3.5 to −2.1; n=42); at 10 minutes, −2.8 (95% CI: −3.7 to −1.9; n = 29). No significant complications were noted.
Conclusion
Intranasal fentanyl provides effective analgesia in acutely injured patients and is a good option for patients in whom immediate intravenous access is complicated by environmental, anatomic, or resource limitations. The potential application for search-and-rescue and other austere medicine situations is widespread.
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