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Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study.
- Source :
-
The American journal of emergency medicine [Am J Emerg Med] 2017 May; Vol. 35 (5), pp. 710-715. Date of Electronic Publication: 2017 Jan 05. - Publication Year :
- 2017
-
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 (N <subscript>2</subscript> O) allow for short recovery time and obviates painful and time-consuming IV access insertions.<br />Methods: We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N <subscript>2</subscript> O 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.<br />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.<br />Conclusion: PSA with IN fentanyl and N <subscript>2</subscript> O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Anxiety drug therapy
Australia
Canada
Child
Child, Preschool
Conscious Sedation methods
Female
Fractures, Bone complications
Humans
Joint Dislocations complications
Male
Pain Measurement
Patient Satisfaction
Prospective Studies
Treatment Outcome
Analgesia
Anesthetics, Inhalation administration & dosage
Fentanyl administration & dosage
Fracture Fixation methods
Fractures, Bone surgery
Joint Dislocations surgery
Nitrous Oxide administration & dosage
Pain prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8171
- Volume :
- 35
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 28190665
- Full Text :
- https://doi.org/10.1016/j.ajem.2017.01.004