Oral transmucosal fentanyl citrate: a novel analgesic agent for use in retinal photocoagulation

To evaluate the analgesic effect of 200 microg oral transmucosal fentanyl citrate during peripheral retinal scatter photocoagulation and to determine the side effect profile.

A prospective, randomized, double-masked crossover study. Consecutive patients (n = 35) undergoing peripheral retinal scatter photocoagulation were randomized into 2 groups. Each attended twice, 1 week apart, and received a standardized laser treatment at each visit. Group one received 200 microg oral transmucosal fentanyl citrate at Visit 1 and placebo at Visit 2. Group 2 received the lozenges in reverse order. After each visit, each patient completed a 100-mm visual analog scale pain score and rating scale regarding systemic side effects.

The mean visual analog scale for patients receiving placebo was 36.4 (SD, 31.5). The mean visual analog scale for patients receiving 200 microg oral transmucosal fentanyl citrate was 19.2 (SD, 20.5) (P = 0.0014). Overall, 4 patients (11%) reported moderate or severe adverse systemic side effects. No clinically significant changes in systemic observations or adverse events occurred.

OTFC at a dosage of 200 microg is an effective and convenient analgesic for use in peripheral retinal scatter photocoagulation. We found this agent to be well tolerated in the outpatient setting. However, a larger study would be required to ascertain safety across a larger population of opiate-naive patients.