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Objectives: Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients., Methods and Methods: In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria., Results: From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group ( P  = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups., Conclusion: Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nebulized fentanyl is well established for analgesia but its use for dyspnea requires further investigation. The aim of our study was to determine the effectiveness of nebulized fentanyl in treating patients with dyspnea and to determine if there were harmful side effects described by patients or their providers. We used a convenience sample of patients from July 1 2014 to July 1 2018 and performed a retrospective chart review. We found that 360 doses of nebulized fentanyl were given to 73 patients during that time period. Of the 73 patients evaluated, 32 patients (43.8%) were female and forty-one were male (56.1%). The median age was 67 and the median length of stay was 9 days. There were no documented findings of bronchospasm, hypotension, or allergic reaction in any of the medical records reviewed. Patients treated with nebulized fentanyl for dyspnea showed a mean decreased respiratory rate of 4.3 breaths/min and a mean increased oxygen saturation of 2.3%. Also, 71% of patients with documented responses experienced an improvement in their dyspnea. Our preliminary data suggest that nebulized fentanyl has limited side effects and may have a role in the treatment of dyspnea. Further research is necessary to determine its efficacy.

An 86-year-old white female was admitted to hospice care with lung cancer. Even with optimal medical management, she suffered from dyspnea and required opioid therapy. However, the patient had a true morphine and hydromorphone allergy. She was administered nebulized fentanyl for symptomatic relief of dyspnea with good effect and she did not experience any allergic response.

Background: This study was aimed to compare the effect of nebulized fentanyl versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery. Patients and Methods: A total of sixty patients scheduled for unilateral femur interlock surgery under subarachnoid block were enrolled in the study and were randomly divided into two groups. Group I included thirty patients who received 2 μg/kg of fentanyl intravenously, and Group N included thirty patients who received 4 μg/kg of fentanyl nebulization using a standard venturi mask. In the postoperative period, whenever the Visual Analog Scale ≥4, patients received the analgesic corresponding to their respective groups. The data obtained were statistically analyzed using IBM SPSS software. Results: There was no significant difference in the demographic characteristics, duration of surgery, the number of patients who required rescue analgesia, and the onset of analgesia in Group N in comparison with Group I. The duration of analgesia was significantly longer in Group N in comparison to Group I. In Group I, the rise in Ramsay sedation score was faster and peaked at 5 min. In Group N, however, it was lesser than that of Group I. Side effects in Group N were significantly lesser compared to Group I. Conclusion: Nebulization with fentanyl is a good alternative to intravenous fentanyl for adequate postoperative pain relief with fewer side effects.

Introduction: Gastric overdistension by mask ventilation during induction of anesthesia in congenital diaphragmatic hernia (CDH) repair may worsen hypoxemia. Topical airway anesthesia may improve the intubating conditions during sevoflurane induction without muscle relaxation. The present study was designed to evaluate the effect of nebulized lidocaine and fentanyl on the intubating conditions without muscle relaxation during sevoflurane induction of anesthesia in infants undergoing CDH repair. The secondary aim was studying hemodynamic changes during induction. Patients and methods: Forty patients scheduled for (CDH) repair were randomly selected and blindly categorized to the following: Nebulizer group: Nebulized solution of 4 mg kg−1 lidocaine 1% plus 2 μg kg−1 fentanyl, Control group: Nebulized solution of comparable volume/weight normal saline 0.9%. Nebulizer of either solution was applied 15 min before sevoflurane induction. Results: Heart rate (HR) and mean arterial blood pressure (mABP) statistically significantly increased in the control group following intubation and for 2 min regarding HR and for 5 min regarding mABP in comparison with the base line and relative to the nebulizer group. There was a statistical significant improvement regarding the intubation conditions in the nebulizer group relative to the control group (p ⩽ 0.001). The same was noticed regarding the intubation time and the number of intubation attempts (p ⩽ 0.001). Conclusions: Premedication of infants undergoing CDH repair with nebulized solution containing 4 mg kg−1 lidocaine 1% plus 2 μg kg−1 fentanyl improves the intubating conditions under inhalational sevoflurane induction without muscle relaxation. The studied combination can suppress patients’ hemodynamic changes to intubation.

Abstract: Context: Activity limitation and dyspnea are the dominant symptoms of chronic obstructive pulmonary disease (COPD). Traditionally, efforts to alleviate these symptoms have focused on improving ventilatory mechanics, reducing ventilatory demand, or both of these in combination. Nevertheless, many patients with COPD remain incapacitated by dyspnea and exercise intolerance despite optimal therapy. Objectives: To determine the effect of single-dose inhalation of nebulized fentanyl citrate (a μ-opioid agonist drug) on exercise tolerance and dyspnea in COPD. Methods: In a randomized, double-blind, placebo-controlled, crossover study, 12 stable patients with COPD (mean±standard error of the mean post-β2-agonist forced expiratory volume in one second [FEV1] and FEV1 to forced vital capacity ratio of 69%±4% predicted and 49%±3%, respectively) received either nebulized fentanyl citrate (50mcg) or placebo on two separate days. After each treatment, patients performed pulmonary function tests and a symptom-limited constant work rate cycle exercise test at 75% of their maximum incremental work rate. Results: There were no significant postdose differences in spirometric parameters or plethysmographic lung volumes. Neither the intensity nor the unpleasantness of perceived dyspnea was, on average, significantly different at isotime (5.0±0.6 minutes) or at peak exercise after treatment with fentanyl citrate vs. placebo. Compared with placebo, fentanyl citrate was associated with 1) increased exercise endurance time by 1.30±0.43 minutes or 25%±8% (P =0.01); 2) small but consistent increases in dynamic inspiratory capacity by ∼0.10L at isotime and at peak exercise (both P ≤0.03); and 3) no concomitant change in ventilatory demand, breathing pattern, pulmonary gas exchange, and/or cardiometabolic function during exercise. The mean rate of increase in dyspnea intensity (1.2±0.3 vs. 2.9±0.8 Borg units/minute, P =0.03) and unpleasantness ratings (0.5±0.2 vs. 2.9±1.3 Borg units/minute, P =0.06) between isotime and peak exercise was less after treatment with fentanyl citrate vs. placebo. Conclusion: Single-dose inhalation of fentanyl citrate was associated with significant and potentially clinically important improvements in exercise tolerance in COPD. These improvements were accompanied by a delay in the onset of intolerable dyspnea during exercise near the limits of tolerance. [Copyright &y& Elsevier]