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Randomized Trial of Intranasal Fentanyl Versus Intravenous Morphine for Abscess Incision and Drainage

Fenster, Daniel B., MS, MD; Dayan, Peter S., MD, MSc; Babineau, John, MD; Aponte-Patel, Linda, MD; Tsze, Daniel S., MD, MPH

doi: 10.1097/PEC.0000000000000810
Original Articles

Objectives Abscess incision and drainage (I&D) are painful and distressing procedures in children. Intranasal (IN) fentanyl is an effective analgesic for reducing symptomatic pain associated with fractures and burns but has not been studied for reducing procedural pain during abscess I&D. Our objective was to compare the analgesic efficacy of IN fentanyl with intravenous (IV) morphine for abscess I&D in children.

Methods We performed a randomized noninferiority trial in children aged 4 to 18 years undergoing abscess I&D in a pediatric emergency department. Patients received IN fentanyl (2 μg/kg; maximum, 100 μg) or IV morphine (0.1 mg/kg; maximum, 8 mg). The primary outcome, determined independently by blinded assessors, was the Observational Scale of Behavioral Distress-Revised (OSBD-R). The prestated margin of noninferiority (Δ) was 1.80. Secondary outcomes included self-reported pain, treatment failure, and patient and parental satisfaction.

Results We enrolled 20 children (median age, 15.4 years), 10 in each group. The difference between total OSBD-R scores was −13.45 (95% confidence interval, −24.24 to −2.67), favoring IN fentanyl.

There was less self-reported pain in patients who received IN fentanyl immediately after the procedure. Four patients (40%) receiving IV morphine had treatment failures and required moderate sedation or had the procedure terminated. More patients who received IN fentanyl were satisfied with the analgesic administered compared with those who received IV morphine.

Conclusions In a small sample of children aged 4 to 18 years undergoing abscess I&D, IN fentanyl was noninferior, and potentially superior, to IV morphine for reducing procedural pain and distress.

From the Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.

Disclosure: The authors declare no conflict of interest.

Unlabeled medication disclosure: Similar to many medications used for the care of children, intranasal fentanyl is not labeled for use in children by the US Food and Drug Administration.

Reprints: Daniel B. Fenster, MS, MD, Division of Pediatric Emergency Medicine, 3959 Broadway, CHN 116, New York, NY 10032 (e-mail:

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