A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting

Study Objective: The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia. Methods: This was a randomized, controlled, open-label trial. Consecutive adult patients (n = 258) requiring analgesia (Verbal Rating Score [VRS] >2/10 noncardiac or >5/10 cardiac) were recruited. Patients received INF 180 mu g +/- 2 doses of 60 mu g at >= 5-minute intervals or IVM 2.5 to 5 mg +/- 2 doses of 2.5 to 5 mg at >= 5-minute intervals. The end point was the difference in baseline/destination VRS. Results: Groups were equivalent (P = not significant) for baseline VRS [mean (SD): INF 8.3 (1.7), IVM 8.1 (1.6)] and minutes to destination [mean (SD): INF 27.2 (15.5), IVM 30.6 (19. 1)]. Patients had a mean (95% confidence interval) VRS reduction as follows: INF 4.22 (3.74-4.71), IVM 3.57 (3.104.03); P =.08. Higher baseline VRS (P <.001), no methoxyflurane use (P <.01), and back pain (P.02) predicted VRS reduction. Safety and acceptability were comparable. Conclusions: There was no significant difference in the effectiveness of TNF and IVM for prehospital analgesia. (C) 2007 Elsevier Inc. All rights reserved.