Intranasal sufentanil provides adequate analgesia for emergency department patients with extremity injuries

Authors

  • Robert Stephen, MD
  • Erin Lingenfelter, PharmD
  • Camille Broadwater-Hollifield, MPH
  • Troy Madsen, MD

DOI:

https://doi.org/10.5055/jom.2012.0121

Keywords:

intranasal, opiate, pain

Abstract

Background: In emergency medicine, the ability to provide rapid, adequate pain control without high resource utilization is ideal. In this study, the efficacy of intranasal sufentanil in emergency department (ED) patients with acute distal extremity injury was evaluated.

Methods: A nonrandomized, open-label dose trial to determine safety and efficacy of intranasal sufentanil in patients with a distal extremity injury who presented to the ED with moderate to severe pain was conducted. Vital signs, pain scores, Ramsay sedation score, and any side effects during a 30-minute observation period after medication administration were recorded. Patients, nurses, and physicians completed satisfaction surveys.

Results: Fifteen ED patients with acute extremity injuries agreed to participate in the study and received a dose of 0.5 µg/kg of sufentanil intranasally. The average pain score decreased 4.3 points (from 7.8 to 3.5). Eight patients reported a final pain score of 3. The most common side effect was mild dysphoria. Patients, physicians, and nurses reported high average satisfaction scores.

Conclusion: Intranasal sufentanil resulted in a significant clinical reduction in patients’ reported pain without serious side effects. This medication and administration route demonstrated promise for potential use in the ED.

Author Biographies

Robert Stephen, MD

Associate Professor (Clinical), Division of Emergency Medicine, Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah

Erin Lingenfelter, PharmD

Department of Pharmacy Services, University of Utah Medical Center, Salt Lake City, Utah

Camille Broadwater-Hollifield, MPH

Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah

Troy Madsen, MD

Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah

References

Helmers JH, Noorduin H, Van Peer A, et al.: Comparison of intravenous and intranasal sufentanil absorption and sedation. Can J Anaesth. 1989; 36(5): 494-497.

Kendall JM, Reeves BC, Latter VS; Nasal Diamorphine Trial Group: Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures. BMJ. 2001; 322(7281): 261-265.

Borland M, Jacobs I, King B, et al.: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med. 2007; 49(3): 335-340.

Dale O, Hjortkjaer R, Kharasch ED: Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand. 2002; 46(7): 759-770.

Chien YW, Su KSE, Chang SF: Anatomy and physiology of the nose. In Nasal Systemic Drug Delivery. New York: Dekker, 1989: chap 1.

Henderson JM, Brodsky DA, Fisher DM, et al.: Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. Anesthesiology. 1988; 68(5): 671-675.

Zedie N, Amory DW, Wagner BK, et al.: Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients. Clin Pharmacol Ther. 1996; 59(3): 341-348.

Karl HW, Keifer AT, Rosenberger JL, et al.: Comparison of the safety and efficacy of intranasal midazolam or sufentanil for preinduction of anesthesia in pediatric patients. Anesthesiology. 1992; 76(2): 209-215.

Lundeberg S, Roelofse JA: Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice. Paediatr Anaesth. 2011; 21: 274-279.

Heshmati F, Noroozinia H, Abbasivash R, et al.: Intranasal sufentanil for postoperative pain control in lower abdominal pediatric surgery. Iranian J Pharmacol Therapeut. 2006; 2(2): 131-133.

Mathieu N, Cnudde N, Engelman E, et al.: Intranasal sufentanil is effective for postoperative analgesia in adults. Can J Anaesth. 2006; 53(1): 60-66.

Published

07/01/2012

How to Cite

Stephen, MD, R., E. Lingenfelter, PharmD, C. Broadwater-Hollifield, MPH, and T. Madsen, MD. “Intranasal Sufentanil Provides Adequate Analgesia for Emergency Department Patients With Extremity Injuries”. Journal of Opioid Management, vol. 8, no. 4, July 2012, pp. 237-41, doi:10.5055/jom.2012.0121.

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Section

Articles