Intranasal fentanyl useful non-invasive option for severe renal colic
Intranasal administration of fentanyl combination with ketorolac can be an appropriate, non-invasive, easy-to-use and fast alternative to the intravenous method to manage pain in these patients, suggests a recently published study.
The
prevalence of kidney stones has increased in the late twentieth and through the
twenty-first centuries. This has been attributed to a variety of factors
including environmental changes, alterations in dietary habits, and increased
prevalence of metabolic syndrome. Renal colic is among the common causes of
sudden and severe pain, especially in tropical areas, and is considered as
emergency management.
Intravenous fentanyl is commonly administrated to patients admitted to
emergency departments, to control severe pain. Nevertheless, different doses of
fentanyl can be delivered through other non-invasive ways such as the
intranasal route. The analgesic efficacy of fentanyl administrated through
intranasal; however, is unclear.
To provide
with an answer to this, Narjes Nazemian et al, at the Department of Emergency
Medicine, Kerman University of Medical Sciences, Kerman, Iran conducted a study
to compare therapeutic efficiencies of intravenous and intranasal routes of
fentanyl administration to manage pain and increase patients' satisfaction in
those with severe renal colic pain referred to emergency departments.
The study design was a single-blinded randomized clinical trial including 220
patients with severe renal colic referred to two emergency departments in
Kerman, southeastern Iran for six months from January 2019 to July 2019. The
study population consisted of Adult patients (i.e. >18 years old) with
severe renal colic pain referred to the emergency departments.
The
patients were randomly assigned to either intramuscular ketorolac + intravenous
fentanyl (IVF) (i.e. control) or intramuscular ketorolac + intranasal fentanyl
(INF) (i.e. intervention) group. The analgesic efficiency of each method was
measured at specific time points in the post-intervention period.
The pain score was determined for 60 minutes. The primary outcome included a
reduction in pain intensity.
On analysis, the following key facts emerged. Of 220 individuals, 96 (43.60%) were women and 124 (56.40%) were men.
There were no significant differences between the two groups regarding the baseline pain severity, age, sex, history of urolithiasis, and body mass index (BMI).
The pain severity showed a significant reducing trend in both groups (p < 0.0001). There was also a significant difference comparing the mean pain severity between groups at different times (p < 0.0001).
In each group, the severity of pain showed a significant reduction compared with its prior measurement (P < 0.0001).