Intranasal administration of fentanyl combination with ketorolac can be an appropriate, non-invasive, easy-to-use and fast alternative to the intravenous method to manage pain in these patients, suggests a recently published study.
The prevalence of kidney stones has increased in the late twentieth and through the twenty-first centuries. This has been attributed to a variety of factors including environmental changes, alterations in dietary habits, and increased prevalence of metabolic syndrome. Renal colic is among the common causes of sudden and severe pain, especially in tropical areas, and is considered as emergency management.
Intravenous fentanyl is commonly administrated to patients admitted to emergency departments, to control severe pain. Nevertheless, different doses of fentanyl can be delivered through other non-invasive ways such as the intranasal route. The analgesic efficacy of fentanyl administrated through intranasal; however, is unclear.
To provide with an answer to this, Narjes Nazemian et al, at the Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran conducted a study to compare therapeutic efficiencies of intravenous and intranasal routes of fentanyl administration to manage pain and increase patients' satisfaction in those with severe renal colic pain referred to emergency departments.
The study design was a single-blinded randomized clinical trial including 220 patients with severe renal colic referred to two emergency departments in Kerman, southeastern Iran for six months from January 2019 to July 2019. The study population consisted of Adult patients (i.e. >18 years old) with severe renal colic pain referred to the emergency departments.
The patients were randomly assigned to either intramuscular ketorolac + intravenous fentanyl (IVF) (i.e. control) or intramuscular ketorolac + intranasal fentanyl (INF) (i.e. intervention) group. The analgesic efficiency of each method was measured at specific time points in the post-intervention period.
The pain score was determined for 60 minutes. The primary outcome included a reduction in pain intensity.
On analysis, the following key facts emerged.
Of 220 individuals, 96 (43.60%) were women and 124 (56.40%) were men.
There were no significant differences between the two groups regarding the baseline pain severity, age, sex, history of urolithiasis, and body mass index (BMI).
The pain severity showed a significant reducing trend in both groups (p < 0.0001). There was also a significant difference comparing the mean pain severity between groups at different times (p < 0.0001).
In each group, the severity of pain showed a significant reduction compared with its prior measurement (P < 0.0001).
Highlighting the results, the team concluded that "Fentanyl can provide a highly effective drug to control pain in patients with severe renal colic referred to emergency departments."

Primary source: American Journal of Emergency Medicine
For full article click on link: https://doi.org/10.1016/j.ajem.2019.158483