Comparing the effectiveness of intravenous fentanyl and nebulised fentanyl in patients presenting to the emergency department with renal colic

Objevtives: To determine the analgesic effectiveness and safety of nebulised fentanyl and compare with intravenous (IV) fentanyl in patients presenting to the emergency department with renal colic. Materials and Methods: A retrospective study was performed to compare the effectiveness of 1.5 µg/kg IV fentanyl and 3.0 µg/kg nebulised fentanyl in patients with renal colic. The effectiveness of the study drugs was measured by a visual analog scale and a verbal rating scale at the baseline and after 15 and 30 min. The adverse effects and need for rescue medication (1.5 µg/kg IV fentanyl) were also recorded at the end of the study. Results: 162 patients were eligible for the enrolment in the study, with 115 patients included in the final analysis (62 in the IV fentanyl group and 53 in the nebulised fentanyl group). The mean±SD age of the patients was 34.3±10.5 years and 83 (%72.2) were men. The mean reduction in scores after study drug administration at 15 min was 39.3 mm (%25-75, 22.75 - 55.5) for IV fentanyl and 17.4 mm (%25-75, –2 - 31) for nebulised fentanyl, at 30 min was 47.4 mm (%25-75, 26.25 – 71) for IV fentanyl and 31.1 mm (%25-75, 10.5 - 52.5) for nebulised fentanyl and at 15-30 min period was 8.1 mm (%25-75, –1 - 19.25) for IV fentanyl and 13.8 mm (%25-75, 0 - 24.5) for nebulised fentanyl. There was a significant difference between pain reduction scores for the two groups at 15 min and 30 min (p < 0.0001 ve p = 0.004 respectively) but the difference was not significant in 15-30 min period (p = 0.443). Rescue medication was needed in 23 patients (%37.1) for IV fentanyl group and 29 patients (%54.7) for nebulised fentanyl group and there was not significant difference between two groups (p=0.058). Fourteen adverse events (%22.6) were recorded in the IV fentanyl group and five (%9.4) in the nebulised fentanyl group and there was not significant difference between the two groups (p = 0.058). Conclusion: Nebulised fentanyl is effective in treating patients presenting with renal colic to the emergency department. IV fentanyl has quicker onset of action and stronger analgesic effect than nebulised fentanyl. IV fentanyl has no superiority to nebulised fentanyl in need of rescue medication. IV fentanyl has relatively more risks than nebulised fentanyl in adverse effects. Key Words: Renal colic, emergency department, fentanyl, nebulised fentanyl