Intranasal Fentanyl as a Pain Management Modality During Dressing Changes in the Outpatient Setting

Abstract

Objective

The purpose of this study was to compare the effectiveness of intranasal (IN) fentanyl versus an oral opioid for managing pain during a pediatric burn dressing change in the outpatient setting.

Methods

Previously healthy children with burn injuries who underwent dressing changes in the outpatient setting were prospectively enrolled in a comparative trial. The patients were matched based on demographics, burn size, and location. The patients were divided into two treatment groups: One group received IN fentanyl immediately before their dressing change, whereas the other group received an oral opioid 30 minutes before their burn clinic visit. Revised Face, Legs, Activity, Cry, Consolability (rFLACC) pain scores were calculated to assess effectiveness.

Results

Sixty-four patients were included (n = 32 per group). rFLACC scores for children who received IN fentanyl decreased from 5.06 ± 2.5 during treatment to 0.50 ± 0.14 after treatment (p < .0001). Similarly, rFLACC scores for children who received an oral opioid decreased from 6.47 ± 2.3 during treatment to 1.19 ± 1.9 after treatment (p < .0001). There was no significant difference in the average rFLACC pain scores of the two groups (p > .05).

Conclusion

IN fentanyl and oral opioid are equally effective for managing pain associated with burn dressing changes in the outpatient setting. However, IN fentanyl showed a more rapid onset of action and provided a more reliable form of pain control.