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Patient-controlled intranasal analgesia: effective alternative to intravenous PCA for postoperative pain relief

From the Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Municipal Hospital Frankfurt-Höchst, Teaching Hospital of the J.W. Goethe-University, Frankfurt a.M., Germany.

Address correspondence to: Prof. Dr. H.W. Striebel, Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Municipal Hospital Frankfurt-Höchst, Gotenstr. 6-8, 65929 Frankfurt a.M. Germany Phone: +49-69-3106 2830; Fax: +49-69-3085 1219; E-mail: Striebel{at}em.uni-frankfurt.de

Purpose: To investigate whether the nasal route for fentanyl administration in patient-controlled analgesia (PCA) provides as effective postoperative analgesia as intravenous PCA.

Methods: Patient-controlled intranasal or intravenous analgesia with fentanyl was investigated in 48 patients (ASA I - III) on the day of surgery (orthopedic, abdominal or thyroid) in a prospective, randomized, double-blind, double-dummy study. Fentanyl was given in a bolus of 25 µg for intranasal and 17.5 µg for iv PCA, lockout interval six minutes. The first requested dose was doubled in both groups. Pain intensity (101-point numerical rating scale) and vital parameters were observed at 11 measurement points during the 240 min study. Patients were asked for side effects at every measurement point and for their satisfaction at the end of the study by the same investigator (J.M.).

Results: Onset of analgesia, the first reduction in pain intensity on the numerical rating scale, was 21 ± 11 min (range 15 – 45 min) in intranasal and 22 ± 16 min (range 15 – 90 min) in iv PCA. Pain intensity was reduced from 55 ± 11 to 11 ± 10 in the intranasal group and from 53 ± 8 to 11 ± 6 in the iv PCA group. Vital parameters remained stable and side effects were comparable in both groups. The judgement "excellent" or "good" was given by 21 of 23 patients treated intranasally and 24 of 25 patients treated intravenously.

Conclusion: Intranasal PCA with fentanyl was an effective alternative to iv PCA in postoperative patients.

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