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Am J Emerg Med. 2017 May;35(5):710-715. doi: 10.1016/j.ajem.2017.01.004. Epub 2017 Jan 5.

Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study.

Author information

1
Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada. Electronic address: julia.hoeffe@insel.ch.
2
Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
3
Emergency Department, Royal Children's Hospital, University of Melbourne, Australia.
4
Division of Orthopedics, Department of Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
5
Emergency Department, Royal Children's Hospital, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; University of Melbourne, Australia.

Abstract

INTRODUCTION:

Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions.

METHODS:

We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation. Facial Pain Scale Revised (FPS-R) and Face, Leg, Activity, Cry, Consolability (FLACC) scores were used to evaluate pain and anxiety before, during and after procedure. University of Michigan Sedation Score (UMSS), adverse events, detailed side effects and satisfaction of patients, parents and medical staff were recorded at discharge. A follow up telephone call was made after 24-72h.

RESULTS:

90 patients were included. There was no difference in FPS-R during the procedure (median score 2 versus 2), but the FLACC score was significantly higher as compared to before (median score 4 versus 0, Δ 2, 95% CI 0, 2). Median UMSS was 1 (95% CI 1, 2). We recorded no serious adverse events. Rate of vomiting was 12% (11/84). Satisfaction was high among participants responding to this question 85/88 (97%) of parents, 74/83 (89%) of patients and 82/85 (96%) of physicians would want the same sedation again.

CONCLUSION:

PSA with IN fentanyl and N2O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.

PMID:
28190665
DOI:
10.1016/j.ajem.2017.01.004
[Indexed for MEDLINE]

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