Transbuccal fentanyl for rapid relief of orthopedic pain in the ED

Shear, Melissa L.; Adler, Jonathan N.; Shewakramani, Sanjay; Ilgen, Jon; Soremekun, Olanrewaju A.; Nelson, Sara; Thomas, Stephen H.

doi:10.1016/j.ajem.2009.04.011

« Previous Next »American Journal of Emergency Medicine
Volume 28, Issue 8 , Pages 847-852, October 2010

Transbuccal fentanyl for rapid relief of orthopedic pain in the ED☆☆☆

Melissa L. Shear
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Jonathan N. Adler, MD
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Sanjay Shewakramani, MD
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Jon Ilgen, MD
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Olanrewaju A. Soremekun, MD
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Sara Nelson, MD
- Massachusetts General Hospital Emergency Services and Harvard Medical School, Boston, MA 02114, USA
Stephen H. Thomas, MD
- Department of Emergency Medicine, OU Schusterman Center, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- Corresponding author. Tel.: +1 918 660 3822; fax: +1 918 660 3821.

Received 9 February 2009; received in revised form 11 April 2009; accepted 14 April 2009. published online 10 March 2010.

Abstract

Objectives

This study's objectives were to assess administration of a rapidly dissolving transbuccal fentanyl tablet to patients in emergency department (ED) with orthopedic extremity pain. The main end point was time required to achieve a 2-point drop on a 0 to 10 pain scale.

Methods

In this double-blind trial, subjects received either transbuccal fentanyl, 100 μg, and a swallowed placebo, or a swallowed oxycodone/acetaminophen, 5/325-mg pill, and a nonanalgesic transbuccal comparator. Pain assessment occurred every 5 minutes for an hour, and vital signs were monitored for 2 hours.

Results

Transbuccal fentanyl was associated with faster pain relief onset (median, 10 vs 35 minutes; P < .0001). Secondary end points (pain relief magnitude, rescue medication rate, subject preference for medication on future visit) favored transbuccal fentanyl. No vital sign abnormalities or significant side effects occurred in the ED or on 100% next-day follow-up.