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Randomized Trial of Intranasal Fentanyl Versus Intravenous Morphine for Abscess Incision and Drainage

Daniel B Fenster1, Peter S Dayan, John Babineau

  • 1From the Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.

Pediatric Emergency Care
|July 9, 2016
PubMed

Insights

Intranasal fentanyl effectively reduced pain and distress in children undergoing abscess incision and drainage (I&D). This study found intranasal fentanyl to be noninferior, and possibly superior, to intravenous morphine for pediatric abscess I&D pain management.

Area of Science:

  • Pediatric Emergency Medicine
  • Pain Management
  • Pharmacology

Background:

  • Abscess incision and drainage (I&D) is a painful procedure for children.
  • Intranasal (IN) fentanyl is a known analgesic but its efficacy for abscess I&D pain has not been studied.
  • Intravenous (IV) morphine is a common analgesic for such procedures.

Purpose of the Study:

  • To compare the analgesic efficacy of IN fentanyl with IV morphine for abscess I&D in children.
  • To evaluate pain and distress reduction during pediatric abscess I&D.
  • To assess patient and parental satisfaction with analgesia.

Main Methods:

  • A randomized noninferiority trial was conducted in children aged 4 to 18 years.
  • Participants received either IN fentanyl (2 μg/kg) or IV morphine (0.1 mg/kg).
  • The primary outcome was the Observational Scale of Behavioral Distress-Revised (OSBD-R), with secondary outcomes including self-reported pain and treatment failure.

Main Results:

  • IN fentanyl showed a statistically significant reduction in OSBD-R scores compared to IV morphine.
  • Patients receiving IN fentanyl reported less pain post-procedure.
  • Treatment failure occurred in 40% of IV morphine patients, compared to none in the IN fentanyl group. Patient and parental satisfaction favored IN fentanyl.

Conclusions:

  • IN fentanyl is noninferior and potentially superior to IV morphine for managing pain and distress during abscess I&D in children.
  • IN fentanyl offers a promising alternative analgesic for pediatric procedural pain.
  • Further research with larger sample sizes is warranted to confirm these findings.
Abstract

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