A Review of Transbuccal Fentanyl Use in the Emergency Department

Annette O Arthur,Peyton Holder

doi:10.1155/2012/768796

Abstract

Patients with severe, painful injuries and illnesses treated in the emergency department are commonly administered opioid medications. Intravenous administration provides the most rapid onset of pain relief and is readily titrated. Fentanyl, administered intravenously, is well documented as an effective medication for pain management in the emergency department. It is preferred in many settings due to its minimal hemodynamic effects, as compared to other commonly used opioids. However, not all patients require intravenous access. These patients are given orally administered pain medications. The oral route is effective at minimizing pain but has a much slower onset of action when compared to the intravenous route. As an alternative to the slower onset of action seen with oral opioids, this paper discusses the use of fentanyl buccal tablet for pain management in the emergency department. Fentanyl buccal tablets are readily absorbed, with a bioavailability of approximately 65%, and have a more rapid onset of action than achieved with traditional oral opioids used in the emergency department.

Highlights

The relief of acute pain secondary to minor orthopedic injuries is often delayed and inadequate in the emergency department [1, 2]
The frequent delay in analgesia delivery is best illustrated by a UK study that revealed a 3-hour 56-minute mean time to receipt of analgesia for patients with moderate pain
The time to pain relief in patients with minor orthopedic injuries could be significantly reduced by an alternative analgesic. This alternative would ideally have a rapid onset and be administered in a simple fashion via a nonparenteral route. With these goals in mind, the authors propose an offlabel indication for fentanyl buccal tablet (FBT) as a novel form of analgesia in the emergency department for patients with isolated minor orthopedic injuries

Summary

A Review of Transbuccal Fentanyl Use in the Emergency Department

Fentanyl, administered intravenously, is well documented as an effective medication for pain management in the emergency department. It is preferred in many settings due to its minimal hemodynamic effects, as compared to other commonly used opioids. The oral route is effective at minimizing pain but has a much slower onset of action when compared to the intravenous route. As an alternative to the slower onset of action seen with oral opioids, this paper discusses the use of fentanyl buccal tablet for pain management in the emergency department. Fentanyl buccal tablets are readily absorbed, with a bioavailability of approximately 65%, and have a more rapid onset of action than achieved with traditional oral opioids used in the emergency department

Introduction

Existing Evidence for Fentanyl Buccal Tablet

Findings

Future Research