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Arnold T, Coffee RL, Rosenberg L, Jacob SA, Thompson S, Saavedra H, Cico SJ, Wagers B. A Quality Improvement Initiative to Decrease Time to Analgesia in Patients With Sickle Cell and Vaso-Occlusive Crisis: A Population With Disparities in Treatment. Cureus 2022; 14:e29569. [PMID: 36312605 PMCID: PMC9595270 DOI: 10.7759/cureus.29569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/25/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Vaso-occlusive crises (VOCs) are the leading cause of emergency department (ED) visits and hospitalizations in patients with sickle cell disease (SCD). Timely administration of analgesia, within 60 minutes of patient registration, is the standard of care for SCD patients with VOCs. Patients with VOCs have longer times to initial analgesia compared to similar painful conditions. The primary aim of the project is to have 75% of patients with VOCs receive initial analgesia within 60 minutes of being registered, the current recommended time frame from the National Heart, Lung, and Blood Institute (NHLBI). Methods: A multi-disciplinary team used quality improvement (QI) methodology to develop a plan involving multiple Plan-Do-Study-Act (PDSA) cycles. A rapid evaluation process was employed which included notification of a patient with a VOC being placed in a room, rapid evaluation by all team members and use of an electronic order set. Results: The aim was met 72% of the time during our intervention period, compared to 17% pre-intervention. Average time to initial analgesia was decreased from 61 minutes to 42 minutes (p-value < 0.001), while time to disposition was also decreased when time goals were achieved. Conclusion: Using a rapid evaluation process we were able to decrease time to initial analgesia in a patient population that has previously experienced delays in care and decrease overall time to disposition.
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A Randomized, Placebo-Controlled Study of Intranasal Fentanyl as an Analgesic Adjunct For Incision and Drainage of Abscess. J Emerg Med 2022; 62:291-297. [PMID: 35067389 DOI: 10.1016/j.jemermed.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/02/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Incision and drainage (I&D) of abscesses is one of the most painful procedures performed in emergency departments (EDs). OBJECTIVE We tested the following hypothesis: The addition of intranasal fentanyl to the standard practice of local infiltration with lidocaine would provide better pain control than lidocaine alone for adult ED patients undergoing I&D. METHODS This was a randomized, double-blind study. Participants received 2 μg/kg of intranasal fentanyl or a comparable amount of intranasal water in addition to local lidocaine infiltration. The primary outcome, which we assessed immediately after the I&D was completed, was a summary 0-10 pain score for which we asked study subjects to provide a number depicting their entire experience with the procedure. RESULTS During a 19-month enrollment period, we screened 176 patients for eligibility and enrolled 49; 25 received placebo and 24 received fentanyl. Baseline characteristics were comparable. Mean (standard deviation) summary pain scores were as follows: fentanyl 6.2 (3.3) and placebo 7.0 (3.2). The 95% confidence interval for a rounded between-group difference of 0.9 was -1.1 to 2.6. CONCLUSIONS In this small study, the addition of intranasal fentanyl did not substantially impact the pain scores of ED patients undergoing I&D.
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Tsai SL, Christie TD, Niemtzow RC. Battlefield acupuncture instead of opioids for abscess drainage in the pediatric emergency department. Am J Emerg Med 2021; 53:12-15. [PMID: 34968969 DOI: 10.1016/j.ajem.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Procedural analgesia with opioids is often needed during incision and drainage (I/D) of pilonidal or large abscesses in the pediatric emergency department (PED). In response to the ongoing opioid misuse pandemic, the Joint Commission has mandated that nonpharmacologic therapies be offered to patients for pain first. Battlefield Acupuncture (BFA) is an auricular acupuncture protocol that is drug free, can achieve rapid pain relief, and is used in the United States military. BFA for painful procedures in the PED has not been reported. We describe 4 cases where BFA was utilized in a PED for pain during I/D of abscesses.
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Affiliation(s)
- Shiu-Lin Tsai
- Department of Emergency Medicine, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 622 West 168th Street, VC 2-260, New York, NY 10032, USA.
| | - Thomas D Christie
- Hunter College, City University of New York, 695 Park Avenue, New York, NY 10065, USA.
| | - Richard C Niemtzow
- United States Air Force Acupuncture and Integrative Medicine Center, Joint Base Andrews, MD 20762, USA
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Filho EM, Riechelmann M. Abscess Incision and Drainage: Which Is the Best Option for Prior Analgesia? Pediatr Emerg Care 2021; 37:e1761. [PMID: 32118831 DOI: 10.1097/pec.0000000000001857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Connell NC, Woodward HA, Flores‐Sanchez PL, McLaren SH, Ieni M, McKinley KW, Shen ST, Dayan PS, Tsze DS. Comparison of preadministered and coadministered lidocaine for treating pain and distress associated with intranasal midazolam administration in children: A randomized clinical trial. J Am Coll Emerg Physicians Open 2020; 1:1562-1570. [PMID: 33392564 PMCID: PMC7771777 DOI: 10.1002/emp2.12227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Pain and distress associated with intranasal midazolam administration can be decreased by administering lidocaine before intranasal midazolam (preadministered lidocaine) or combining lidocaine with midazolam in a single solution (coadministered lidocaine). We hypothesized coadministered lidocaine is non-inferior to preadministered lidocaine for decreasing pain and distress associated with intranasal midazolam administration. METHODS Randomized, outcome assessor-blinded, noninferiority trial. Children aged 6 months to 7 years undergoing laceration repair received intranasal midazolam with preadministered or coadministered lidocaine. Pain and distress were evaluated with the Observational Scale of Behavioral Distress-Revised (OSBD-R) (primary outcome; non-inferiority margin 1.8 units) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Faces, Legs, Activity, Cry, Consolability (FLACC) scales and cry duration (secondary outcomes). Secondary outcomes also included adverse events, clinician and caregiver satisfaction, and pain and distress associated with intranasal lidocaine administration. RESULTS Fifty-one patients were analyzed. Mean OSBD-R scores associated with intranasal midazolam administration were 6.4 (95% confidence interval [CI] 5, 7.8) and 7 (95% CI 5.2, 8.9) units for preadministered and coadministered lidocaine, respectively. The difference of 0.6 (95% CI -1.7, 2.8) units represented an inconclusive non-inferiority determination. CHEOPS and FLACC scores and cry duration were similar between groups. OSBD-R, CHEOPS, and FLACC scores and cry duration associated with intranasal lidocaine administration were 3.8, 9.9, and 6 units, and 56 seconds, respectively. Clinicians considered coadministered lidocaine easier to administer. CONCLUSION Pain and distress associated with intranasal midazolam administration were similar when using coadministered or preadministered lidocaine, but our non-inferiority determination was inconclusive. Administration of intranasal lidocaine by itself was associated with a measurable degree of pain and distress.Keywords: intranasal, midazolam, anxiolysis, sedation, emergency department, emergency medicine, pain, distress, pediatric, lidocaine, laceration.
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Affiliation(s)
- Nicole C. O'Connell
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
- Department of Emergency MedicineWestchester Medical CenterValhallaNew YorkUSA
| | - Hilary A. Woodward
- Department of Child LifeNewYork‐Presbyterian Morgan Stanley Children's HospitalNew YorkNew YorkUSA
| | - Pamela L. Flores‐Sanchez
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Son H. McLaren
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Maria Ieni
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Kenneth W. McKinley
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
- Division of Pediatric Emergency MedicineChildren's National HospitalWashingtonDCUSA
| | - Sripriya T. Shen
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Peter S. Dayan
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Daniel S. Tsze
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
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Abstract
This paper is the forty-first consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2018 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (2), the roles of these opioid peptides and receptors in pain and analgesia in animals (3) and humans (4), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (5), opioid peptide and receptor involvement in tolerance and dependence (6), stress and social status (7), learning and memory (8), eating and drinking (9), drug abuse and alcohol (10), sexual activity and hormones, pregnancy, development and endocrinology (11), mental illness and mood (12), seizures and neurologic disorders (13), electrical-related activity and neurophysiology (14), general activity and locomotion (15), gastrointestinal, renal and hepatic functions (16), cardiovascular responses (17), respiration and thermoregulation (18), and immunological responses (19).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers. Pediatr Emerg Care 2020; 36:e494-e499. [PMID: 30789872 DOI: 10.1097/pec.0000000000001782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers. METHODS This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions. RESULTS Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2-17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99-4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07-0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6-4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03-0.45) mg/kg. There were no serious adverse drug reactions reported. CONCLUSIONS Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.
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Assessing procedural satisfaction in the pediatric ED: A systematic review. Am J Emerg Med 2020; 43:283-286. [PMID: 32693939 DOI: 10.1016/j.ajem.2020.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
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O'Connell NC, Woodward HA, Flores-Sanchez PL, McLaren SH, Ieni M, McKinley KW, Shen ST, Dayan PS, Tsze DS. WITHDRAWN: Comparison of Preadministered and Coadministered Lidocaine for Treating Pain and Distress Associated With Intranasal Midazolam Administration in Children: A Randomized Clinical Trial. Ann Emerg Med 2020:S0196-0644(20)30292-4. [PMID: 32507490 DOI: 10.1016/j.annemergmed.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
This article has been withdrawn at the request of the authors and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Nicole C O'Connell
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Emergency Medicine, Westchester Medical Center, Valhalla, NY
| | - Hilary A Woodward
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY; NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Pamela L Flores-Sanchez
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Son H McLaren
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Maria Ieni
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Kenneth W McKinley
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Sripriya T Shen
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Peter S Dayan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Daniel S Tsze
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Nazemian N, Torabi M, Mirzaee M. Atomized intranasal vs intravenous fentanyl in severe renal colic pain management: A randomized single-blinded clinical trial. Am J Emerg Med 2019; 38:1635-1640. [PMID: 31740092 DOI: 10.1016/j.ajem.2019.158483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Renal colic is one of the most common painful disorders in patients referred to the emergency department. The main purpose of this study was to compare the efficiency of two methods of intravenous (IVF) and intranasal (INF) fentanyl administration in pain management in patients with severe renal colic. MATERIALS & METHODS This was a single-blind randomized clinical trial performed on patients with severe renal colic. The severity of pain was ≥8 based on the Numerical Rating Scale (NRS). The efficacy of pain management was compared within and between the IVF (intramuscular Ketorolac + intravenous fentanyl) and INF (intramuscular Ketorolac + intranasal fentanyl) groups at different times points. Oral consent was obtained from all the patients. RESULTS Of 220 individuals, 96 (43.60%) were women and 124 (56.40%) were men. There were no significant differences between the two groups regarding the baseline pain severity, age, sex, history of urolithiasis and body mass index (BMI). The pain severity showed a significant reducing trend in both groups (p < 0.0001). There was also a significant difference comparing the mean pain severity between groups at different times (p < 0.0001). In each group, the severity of pain showed significant reduction compared with its prior measurement (P < 0.0001). CONCLUSION Fentanyl is highly effective in controlling pain in patients with severe renal colic referring to the emergency department. Intranasal administration of fentanyl combination with ketorolac can be an appropriate, non-invasive, easy-to-use and fast alternative to the intravenous method to manage pain in these patients.
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Affiliation(s)
- Narjes Nazemian
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Torabi
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Moghaddameh Mirzaee
- Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Setlur A, Friedland H. Treatment of pain with intranasal fentanyl in pediatric patients in an acute care setting: a systematic review. Pain Manag 2018; 8:341-352. [PMID: 30278812 DOI: 10.2217/pmt-2018-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The primary objective of this review is to provide an updated, comprehensive overview on the efficacy of intranasal fentanyl (INF) for acute pain relief in the pediatric population. METHODS Utilizing the Preferred Reporting Instructions for Systematic Reviews and Meta-Analyses (PRISMA), we were able to screen articles based on key words to reach a final number of 10 studies. RESULTS All but one study showed that INF was efficacious for pain relief in this select pediatric population. CONCLUSION It is evident that INF is efficacious for analgesia, but other agents should also be considered in this patient population. As a result, further research is needed to investigate the clinically efficacy of INF in an acute care setting for pediatric patients.
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Affiliation(s)
- Anuradha Setlur
- Department of Pediatrics, St. Joseph's Medical Center, Paterson, NJ 07503, USA
| | - Howard Friedland
- Department of Pediatrics, St. Joseph's Medical Center, Paterson, NJ 07503, USA
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The Needle-Less Treatment of Pain and Anxiety in the Pediatric Patient. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fein DM, Avner JR, Scharbach K, Manwani D, Khine H. Intranasal fentanyl for initial treatment of vaso-occlusive crisis in sickle cell disease. Pediatr Blood Cancer 2017; 64. [PMID: 27862905 DOI: 10.1002/pbc.26332] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/20/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Analgesia administration for children with vaso-occlusive crises is often delayed in the emergency department. Intranasal fentanyl (INF) has been shown to be safe and effective in providing rapid analgesia for other painful conditions. Our objective was to determine if children with a vaso-occlusive crisis (VOC) who received initial treatment with INF compared to placebo achieved a greater decrease in pain score after 20 min. PROCEDURE This was a randomized, double-blind, placebo-controlled trial. Children with sickle cell disease, 3-20 years old, not taking daily opiates were eligible for the study. Subjects who presented to the emergency department with a pain score ≥6 were randomized to either a single dose of INF (2 μg/kg, maximum 100 μg) or an equivalent volume of intranasal saline. Pain scores were obtained using a modified Wong-Baker FACES pain scale prior to the administration of study drug and at 10, 20, and 30 min afterward. Additional analgesic medication was given per standard protocol. RESULTS Forty-nine subjects completed the study (24 fentanyl and 25 placebo). Subjects who received INF had a greater decrease in median pain score at 20 min compared to placebo (2 [interquartile range, (IQR) 0.5-4] vs. 1 [IQR 0-2], P = 0.048), but not at 10 or 30 min. There were no serious adverse events in either group. CONCLUSION Children who received INF had a greater decrease in pain score at 20 min compared to those who received placebo. Further studies should evaluate how to best incorporate INF into the emergency care of a child with a VOC.
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Affiliation(s)
- Daniel M Fein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jeffrey R Avner
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Scharbach
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Deepa Manwani
- Division of Pediatric Hematology-Oncology Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Hnin Khine
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Bartoszek MW, McCoart A, Hong KSJ, Haley C, Highland KB, Plunkett AR. An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints. J Pain Res 2017; 10:359-364. [PMID: 28243139 PMCID: PMC5315349 DOI: 10.2147/jpr.s124180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures. Patients and methods This cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg) administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings. Results No adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment. Conclusion Preliminary evidence indicates that intranasal fentanyl is safe and effective for lumbar facet radiofrequency ablation procedures. Future rigorous randomized control trials are needed to confirm the present results and to examine the effects of intranasal fentanyl on intraoperative and postoperative opioid use.
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Affiliation(s)
| | - Amy McCoart
- Clinical Investigations, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, NC
| | - Kyung-Soo Jason Hong
- Research Department, The Center for Clinical Research, Sceptor Pain Foundation, Winston Salem, NC
| | - Chelsey Haley
- Clinical Investigations, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Womack Army Medical Center, Fort Bragg, NC
| | - Krista Beth Highland
- Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Uniformed Services University, Bethesda, MD, USA
| | - Anthony R Plunkett
- Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, NC
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