Safety and Efficacy of Oral Transmucosal Fentanyl Citrate for Prehospital Pain Control on the Battlefield
Morphine has been the mainstay for prehospital battlefield analgesia, with its use dating back to the War of 1812 and the American Civil War. Although morphine is an excellent analgesic, its significant adverse effects include cardiorespiratory depression, immune function suppression, and titration difficulties. Oral transmucosal fentanyl citrate (OTFC) is a potent alternative with a faster onset and fewer adverse effects.
This study was a retrospective analysis of the prehospital use of OTFC in Afghanistan and Iraq from 2003 to 2010. In all, 286 patients received OTFC for various injuries, with traumatic extremity injuries being the most common. The primary outcome was pain assessment using the numerical rating system at 0, 15, and 30 minutes after OTFC administration. Continuous pulse oximetry was utilized, and adverse events were recorded. The OTFC lowered pain scores in 97% of patients, with a mean dose of 962.4 µg. Approximately 18% of patients required other analgesics for adequate pain control. Only 1 significant adverse event was recorded in the setting of hypoventilation, requiring low-dose naloxone. Minor adverse events included nausea, pruritus, drowsiness, and dizziness. Major benefits of OTFC included ease of administration, rapid onset, and ability to titrate safely and effectively.
Limitations of the study include retrospective design, inadequate documentation, and limited follow-up data. The authors recognized the potential use OTFC for acute pain in civilian prehospital and austere environments.
(J Trauma Acute Care Surg. 2012;73[suppl 5]:490-495) IS Wedmore, RS Kotwal, JG McManus, et al.