Faculty Mentor
Billy Sin
Major/Area of Research
Pharmacy Practice
Description
Introduction: Acute pain management in the emergency department (ED) requires prompt administration of safe and effective analgesia. ¬Traditional routes of administration for analgesia includes the oral (PO), intravenous (IV), or intramuscular routes (IM). When these routes of administration are not feasible, the intranasal (IN) route may be considered. Furthermore, a rapid onset of therapeutic effects may be observed due to the rich capillary network of the respiratory mucosa that is able to promptly transport the drug into systemic circulation. There is emerging literature that supports the use of analgesia via the IN route in the Emergency Department (ED). However, its use is often a topic of controversy due to the limited familiarity of medications that may be administered via the IN route, lack of readily available administration devices, and training on specific techniques necessary to use the devices appropriately.
Methods: This was a single-center, prospective, randomized, double-blind, placebo-controlled trial which evaluated the use of IN sufentanil in adult patients who presented to the ED with acute pain. Patients were randomized to receive IN sufentanil 0.7mcg/kg or IV morphine 0.1mg/kg. The primary outcome was patient’s pain score as reported via the Numeric Rating Scale (NRS). Secondary outcomes were adverse events, consumption of rescue analgesia, and patient satisfaction of treatment.
Results: Thirty patients were enrolled in each group. No significant difference (sufentail: 2.0 (interquartile range [IQR])=1.0-3.0 vs. morphine: 3.0, IQR=2.0-5.3, p=0.198) in the median pain scores was detected at 10 minutes after study intervention. No serious adverse events occurred. A significant difference in the median respiratory rate was detected at 10 minutes between the two groups (sufentanil: 17 bpm (IQR= 17-22) vs. morphine 18bpm (IQR= 14-19), p=0.014. Median oxygen saturation at 5 minutes was also statistically significantly different (sufentail: 100% (IQR = 98-100) vs. morphine: 98% (IQR= 96-100). No difference was detected in the amount of rescue analgesia utilized or length of stay. Patient satisfaction scores by the end of treatment were similar (sufentail: 10 (IQR= 7.8-10 vs. morphine 8 (IQR: 6-10), p=0.152.
Conclusion: There is no significant difference in reduction of pain scores between IN sufentanil vs IV morphine for patients who presented to the ED with acute pain.
Keywords
COVID-19, Online Education, Family Outreach
Included in
Intranasal sufentail vs. intravenous morphine for acute pain in the emergency department
Introduction: Acute pain management in the emergency department (ED) requires prompt administration of safe and effective analgesia. ¬Traditional routes of administration for analgesia includes the oral (PO), intravenous (IV), or intramuscular routes (IM). When these routes of administration are not feasible, the intranasal (IN) route may be considered. Furthermore, a rapid onset of therapeutic effects may be observed due to the rich capillary network of the respiratory mucosa that is able to promptly transport the drug into systemic circulation. There is emerging literature that supports the use of analgesia via the IN route in the Emergency Department (ED). However, its use is often a topic of controversy due to the limited familiarity of medications that may be administered via the IN route, lack of readily available administration devices, and training on specific techniques necessary to use the devices appropriately.
Methods: This was a single-center, prospective, randomized, double-blind, placebo-controlled trial which evaluated the use of IN sufentanil in adult patients who presented to the ED with acute pain. Patients were randomized to receive IN sufentanil 0.7mcg/kg or IV morphine 0.1mg/kg. The primary outcome was patient’s pain score as reported via the Numeric Rating Scale (NRS). Secondary outcomes were adverse events, consumption of rescue analgesia, and patient satisfaction of treatment.
Results: Thirty patients were enrolled in each group. No significant difference (sufentail: 2.0 (interquartile range [IQR])=1.0-3.0 vs. morphine: 3.0, IQR=2.0-5.3, p=0.198) in the median pain scores was detected at 10 minutes after study intervention. No serious adverse events occurred. A significant difference in the median respiratory rate was detected at 10 minutes between the two groups (sufentanil: 17 bpm (IQR= 17-22) vs. morphine 18bpm (IQR= 14-19), p=0.014. Median oxygen saturation at 5 minutes was also statistically significantly different (sufentail: 100% (IQR = 98-100) vs. morphine: 98% (IQR= 96-100). No difference was detected in the amount of rescue analgesia utilized or length of stay. Patient satisfaction scores by the end of treatment were similar (sufentail: 10 (IQR= 7.8-10 vs. morphine 8 (IQR: 6-10), p=0.152.
Conclusion: There is no significant difference in reduction of pain scores between IN sufentanil vs IV morphine for patients who presented to the ED with acute pain.