Nebulized Fentanyl in Acute Pain: A Systematic Review

• Published in: Annals of Pharmacotherapy 2016-10, Vol.50 (10), p.882-891
• Main Authors: Thompson, Joshua P., Thompson, Dennis F.
• Format: Article
• Language: English
• Subjects: Acute Pain - drug therapy; Acute Pain - metabolism; Administration, Inhalation; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - pharmacokinetics; Analgesics, Opioid - therapeutic use; Child; Clinical Trials as Topic; Fentanyl - administration & dosage; Fentanyl - pharmacokinetics; Fentanyl - therapeutic use; Humans; Nebulizers and Vaporizers; Pain Measurement; Tissue Distribution
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028016659077

Objective: To provide a systematic review of the current role of nebulized fentanyl in acute pain and potentially other conditions. Data Sources: A MEDLINE literature search inclusive of the dates 1946 to May 2016 was performed using the following search terms: fentanyl and administration, inhaled. Excerpta Medica was searched from 1980 to May 2016 using the following search terms: exp fentanyl/inhalation drug administration. Additionally, Web of Science was searched using the terms fentanyl and pain inclusive of 1945 to May 2016. Study Selection and Data Extraction: We utilized the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to select English language, human primary literature, review articles, and supporting data assessing the efficacy of nebulized fentanyl in acute pain. Data Synthesis: Seven clinical trials have demonstrated no difference in efficacy between nebulized fentanyl and intravenous (IV) opioids. Few adverse effects were reported; however, the trials were of short duration. Nebulized fentanyl appeared to be a rapid-acting analgesic that does not require IV access. Conclusion: Evidence suggests that nebulized fentanyl is as effective as IV opioids in the treatment of acute pain, with relatively few adverse effects. However, questions remain about the extemporaneous preparation of fentanyl nebulized solution, the variability in nebulization devices, and ensuring consistent drug delivery to distal airways in the clinical setting. The abuse potential of nebulized fentanyl should also be considered.