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Is it time to change? The use of intranasal fentanyl for severe pain in the pre-hospital setting

02 November 2014
Volume 6 · Issue 11

Abstract

The treatment of pain is a commonplace issue for today's paramedics, where the need for new analgesics to overcome cannulation barriers is gathering momentum. Intranasal fentanyl has proven itself to be a very safe and effective form of analgesia that overcomes those barriers and can help paramedics provide a higher standard of care. Although research into its use in the pre-hospital environment is still limited, evidence of its effectiveness in the accident and emergency department has highlighted its potential for helping paramedics treat severe pain where venous access is compromised. Studies have shown that intranasal fentanyl compares with the analgesic standard set by intravenous morphine and is rapidly becoming the drug of choice in the paediatric accident and emergency department.

Second to illness, pain is the most common symptom that paramedics working in the pre-hospital environment assess and treat on a daily basis (Cordell et al, 2002; Alonso-Serra and Wesley, 2003; Weber et al, 2012). A review of patient report forms have shown that approximately 20% of patients reported moderate to severe pain upon arrival of the paramedics (McLean et al, 2002), of which 1 in 5 expressed a need for more or better pain relief (Siriwardena et al, 2010). When mild to moderate pain is factored into the equation, it is clear that good pre-hospital pain management is a large component in the role of the modern day paramedic (Weber et al, 2012). For paediatric hospital emergency attendances, 60% are attributed to injuries that require analgesic intervention (College of Emergency Medicine Clinical Effectiveness Committee, 2013).

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