The following is a summary of “IF IM in a crisis: Intranasal fentanyl versus intravenous morphine in adult vaso-occlusive crisis,” published in the February 2023 issue of Emergency Medicine by Assad, et al.

Studies showed that INF was effective in lowering pain ratings in adult patients with chronic pain disorders other than VOC, such as cancer, and in pediatric patients with VOC caused by sickle cell disease (SCD). The role of INF in adult patients with VOC caused by SCD was, however, very briefly described in the literature currently available. The use of IV morphine for VOC patients reduced pain, according to recent evidence. The efficacy of INF for VOC patients would be determined by contrasting its usage with that of IV morphine. For a study, researchers sought to ascertain if IV morphine and intranasal fentanyl were similarly efficacious in treating adult SCD patients’ VOC-related pain. 

Retrospective non-inferiority cohort research was used in the study. Between January 1, 2021, and February 28, 2022, eligible patients were found using electronic health records. Patients who got INF as their first opioid after being seen in the emergency department (ED) were assigned to the intervention group. Individuals who first got IV morphine as an opioid upon admission to the ED, on the other hand, were placed in the control group. Patients who were 18 years of age or older and had been diagnosed with VOC owing to SCD were admitted to the ED and were given INF or IV morphine as the first painkiller. The main result was to compare the groups’ differences in the percentage of pain reduction following the initial opiate dosage. Secondary outcomes included readmission within 48 hours, ED disposition, hypotension, bradycardia, respiratory distress requiring opiate reversal within 6 hours post-study drug administration, total morphine milligram equivalent (MME) of IV opiates, and delay to first rescue medicine.

About 230 patients were examined during the trial; 95 participants satisfied the criteria for inclusion; 31 people were assigned to the INF arm, and 64 subjects were assigned to the IV morphine arm. In the main outcome, there was an average 17.25% pain reduction in the INF arm and a 17.15% pain reduction in the IV morphine arm. The point estimate difference was 0.1% (95% CI −9.3%–9.5%; non-inferiority (P < 0.0001). In the INF group, the median IV opiate dosage was 8 MME, but in the IV morphine group, it was 6 MME (P = 0.0268). The interval between the study drug and the first rescue medicine delivery was 22.4 and 27.3 minutes, respectively, in the INF and IV morphine groups (P = 0.2231). In neither arm was there a case of hypotension or respiratory distress that required opiate reversal. In the INF and IV morphine groups, respectively, bradycardia occurred in 12.9% and 7.7% (P = 0.2042), readmission rates within 48 hours owing to VOC were 6.5% and 20.9% (P = 0.0553), and discharge from the ED to home was 16% & 66% (P = 0.0196).

In treating individuals arriving at the ED with VOC, INF offered a comparable pain reduction to IV morphine.

Reference: sciencedirect.com/science/article/pii/S0735675722007318