View Full Version : Pain Management

08-31-2004, 16:17
Just found this on one of my emails...thought it would be of interest: see below article for my comments.

NEW YORK (Reuters Health) Aug 24 - Oral transmucosal fentanyl, which is currently indicated for chronic cancer pain, is also useful for pain control in trauma patients without immediate hospital access, such as in a combat situation, according to a report published in the Annals of Emergency Medicine for August.

The findings are based on a study of 22 military personnel who sustained injuries and received the drug while serving in Iraq last year. All of the subjects were hemodynamically stable and had uncomplicated orthopedic injuries or extremity wounds.

Within 15 minutes of receiving transmucosal fentanyl, a significant improvement in verbal pain scores occurred, lead author Dr. Russ S. Kotwal, from the University of Texas in Galveston, and colleagues note. Moreover, the level of pain control remained stable for the next 5 hours without the need for redosing.

Hypoventilation, which was noted in one patient, resolved readily when naloxone was given, the authors note. Other side effects were mild and included pruritus in five patients, nausea in three, emesis and lightheadedness in two each.

"Oral transmucosal fentanyl citrate can provide an alternative means of delivering effective, rapid-onset, and noninvasive pain management in an out-of-hospital, combat, or austere environment," the researchers conclude.

Ann Emerg Med 2004;44:121-127.

my 2 cents: Any pain med given in the field needs to accomplish several things
First: provide enough analgesia to ease the 'burden' of pain for the patient while enabling them to remain awake, breathing and potentially assisting in their care or defense, if the wound is not of the magnitude that requires them to be intubated.
Second: it needs to be easily titratable with an easy/reliable route of administration. As you all know the 'luxury' of being evac'ed promptly may not be a reality. By mouth, IV which ever but reliable is the key. It could be wiped into the mucosa of the mouth if intubated I guess???
Nice thing about fentanyl, small volume goes a long way,,, bad part is short acting. Not sure why they showed a 5 hour period of no re-dosing, i.e., was the pain insignificant enough to not require analgesics to begin with.
I love the power of the written word. Without all of the facts, someone could just decide to do away with IV meds and switch to the oral/transmucosal route!!! I hope not!
But, I thought it makes for interesting reading incase anyone is approached to be involved with studying its use in the field.

Roguish Lawyer
08-31-2004, 16:38
See here for more on this:


08-31-2004, 17:51
How did I miss that thread.....sorry for "old" news...but the commentary still fits

08-31-2004, 19:02
I believe you were on your vacation during that thread, Sir. :cool: