Nebulized Fentanyl vs. Intravenous Morphine for Abdominal Pain

Published in Am J Emerg Med 2015 Mar 25;

Authors: Deaton T et al.

In a small randomized trial, nebulized fentanyl produced better pain relief and satisfaction than intravenous morphine.

Fentanyl, a potent opioid with minimal hemodynamic effects, can be delivered by a variety of routes. In a randomized trial, investigators compared nebulized fentanyl (2 µg/kg) and intravenous morphine (0.1 mg/kg) for pain relief in 32 adult emergency department patients with acute abdominal pain. Fentanyl was delivered by a breath-actuated nebulizer designed to prevent release of the drug into the air.

Pain was measured on a visual analog scale at baseline and every 10 minutes for 40 minutes. Pain relief was superior with nebulized fentanyl, with a greater decrease from baseline at all time points. Of patients receiving nebulized fentanyl, 81% reported satisfaction, versus 25% of those receiving intravenous morphine. There were no significant adverse events.

Comment
This was a small single-center study in which only one dose of each medication was given, therefore it cannot prove that the two regimens are equivalent. But it provides compelling evidence that breath-actuated nebulized fentanyl is a viable option that merits further consideration.