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

Purpose: To investigate; whether the nasal route for fentanyl administratio n in patient-controlled analgesia (PCA) provides as effective postoperative analgesia as intravenous PCA, Methods: Patient-controlled intranasal or intravenous analgesia with fentan yl was investigated in 48 patients (ASA I - III) on the day of surgery (ort hopedic, abdominal or thyroid) in a prospective, randomized, double-blind, double-dummy study. Fentanyl was given in a bolus of 25 mu g for intranasal and 17.5 mu g for iv PCA, lockout interval six minutes, The first requeste d dose was doubled in both groups, Pain intensity(101-point numerical ratin g scale) and vital parameters were observed at 11 measurement points during the 240 min study. Patients were asked for side effects at every measureme nt point and for their satisfaction at the end of the study by the same inv estigator (J.M.). Results: Onset of analgesia, the first reduction in pain intensity on the n umerical rating scale, was 21 +/- 11 min (range 15-45 min) in intranasal an d 22 +/- 16 min (range 15 - 90 min) in Tv PCA. Pain intensity was reduced f rom 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 effect s were comparable in both groups. The judgement "excellent" or "good" was g iven by 21 of 23 patients treated intranasally and 24 of 25 patients treate d intravenously. Conclusion: Intranasal PCA with fentanyl was an effective alternative to iv PCA in postoperative patients.