Comparing Analgesic Efficacy of Intranasal Fentanyl Using Mucosal Atomization Device Versus Intravenous Fentanyl for Management of Breakthrough Pain in Head and Neck Cancer Patients: A Randomized Clinical Trial.

Abstract

Aim: The purpose of this study is to compare the analgesic efficacy of intranasal fentanyl versus intravenous fentanyl and their role in reducing the pain intensity in breakthrough pain in patients with head and neck cancer.

Material and methods: This study includes 30 patients who were diagnosed with head and neck cancer and underwent surgery for the same. Patients were divided into 2 groups: group A receiving intranasal fentanyl 1 mcg/kg using mucosal atomization device and group B receiving intravenous fentanyl 1 mcg/kg when the patient complained of the breakthrough pain postoperatively; both the groups received 1 g paracetamol IV every 8 hourly. The primary outcome pain was assessed using FLACC scale.

Results: Onset of action of drug was an average of 5 min in group A and 15 min in group B. No incidence of bradycardia, hypotension was seen in both the groups.

Conclusions: We concluded that intranasal administration of fentanyl provides better postoperative breakthrough pain relief and opioids are the rescue medication of choice for breakthrough pain and it should be individually titrated as needed to achieve adequate pain relief while minimizing the risk of side effects.