The Efficacy of Fentanyl for Pain Management in Emergency Department: Review Article

  • Sara Payami Emergency Department of Imam Reza Hospital, Kermanshah, Iran.
Keywords: acute pain, analgesia, fentanyl, pain management, emergency department


 Fentanyl is a strong opioid and it is widely used for pain relief. In this review, we evaluated the efficacy of fentanyl in pain management in the emergency department. For this review, we searched scientific search engines including google, google scholar, Cochrane library, Medline, and PubMed and collected original articles, including randomized controlled trials, comparative studies, cohort and case series related to fentanyl and its administration in the emergency department from 2010 to 2016. In this review, 8 articles and 44493 patients were evaluated. Four articles were retrospective and 4 articles were prospective of these four articles were randomized placebo controlled and double blinded. Among eight articles, six of them compared the efficacy and adverse events of fentanyl with other opioids. We found fentanyl significantly decreases pain intensity in patient with acute pain in the emergency department. Moreover, it is more effective than morphine and methoxyflurane.    


Tanabe P, Buschmann M. A prospective study of ED pain management practices and the patients prospective. J Emerg Nurs. 1999; 25(3):171-7.

Garbez RO, Chan GK, Neighbor M, Puntillo K. Pain after discharge: A pilot study of factors associated with pain management and functional status. J Emerg Nurs. 2006; 32(4):288-93.

Dillard J, Knapp S. Complementary and Alternative Pain Therapy in the Emergency Department. Emerg Med Clin North Am. 2005; 23(2):529-49.

Sephton VC, Shaw A, Cowan CM. Sedation and analgesia for transvaginal oocyte retrieval: an audit resulting in a change of clinical practice. Human Fertility. 2001; 4(2): 94-98.

Jones N, Long L, Zeitz K. The role of the nurse sedationist. Collegian. 2011; 18(3): 115-23.

Gutstein HB, Akil H. Opioid analgesics. In: Hardman JG, Limbrid LE, Gilman AG, eds. Goodman and Gilman’s the Pharmacological Basis of Therapeutics. 10th edition. New York, NY: McGraw-Hill; 2001:569-619.

Scott JC, Ponganis KV, Stanski DR. EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology. 1985; 62(3):234-41.

Grape S, Schug SA, Lauer S, Schug BS. Formulations of fentanyl for the management of pain. Drugs. 2010; 70(1):57-72.

Browne B, Linter S. Monoamine oxidase inhibitors and narcotic analgesics. A critical review of the implications for treatment. Br J Psychiatry. 1987; 151:210–2.

Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ. Cardiac surgery in a patient taking monoamine oxidase inhibitors: an adverse fentanyl reaction. Anesth Analg. 1994; 78(3):593-7.

Food and Drug Administration. FDA warns of potential serious side effects with breakthrough cancer pain drug [press release]. Silver Spring (MD): FDA; September 26, 2007. Available from: NewsEvents/ Newsroom/ PressAnnouncements/ 2007/ucm108994.htm. Accessed June 1, 2011.

Knill R, Cosgrove JF, Olley PM, Levison H. Components of respiratory depression after narcotic premedication in adolescents. Can Anaesth Soc J. 1976; 23(5):449-58.

Rigg JR, Goldsmith CH. Recovery of ventilatory response to carbon dioxide after thiopentone, morphine and fentanyl in man. Can Anaesth Soc J. 1976; 23(4):370–82.

Cephalon. ACTIQ® (oral transmucosal fentanyl citrate) [package insert]. Salt Lake City: Cephalon, Inc.; 2011.

Hansen MS, Dahl JB. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting – a systematic review. Dan Med J 2013; 60(1):A4563

Borland M, Milsom S, Esson A. Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial. Emerg Med Australas. 2011; 23(2):202-8.

Holdgate A, Cao A, Lo KM. The implementation of intranasal fentanyl for children in a mixed adult and pediatric emergency department reduces time to analgesic administration. Acad Emerg Med. 2010; 17(2):214-7.

Ziegler DK. Opioids in headache treatment: is there a role? Neurol Clin. 1997; 15(1):199-207.

Deaton T, Auten JD, Darracq MA. Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial. Am J Emerg Med. 2015; 33(6):791-5.

Farahmand S, Shiralizadeh S, Talebian MT, Bagheri-Hariri S, Arbab M, Basirghafouri H, Saeedi M, Sedaghat M, Mirzababai H. Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: a randomized clinical trial. Am J Emerg Med. 2014; 32(9):1011-5.

Wenderoth BR, Kaneda ET, Amini A, Amini R, Patanwala AE. Morphine versus fentanyl for pain due to traumatic injury in the emergency department. J Trauma Nurs. 2013; 20(1):10-5.

Fleischman RJ, Frazer DG, Daya M, Jui J, Newgard CD. Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. Prehosp Emerg Care. 2010; 14(2):167-75.

Johnston S, Wilkes GJ, Thompson JA, Ziman M, Brightwell R. Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service. Emerg Med J. 2011; 28(1):57-63.

Middleton PM, Simpson PM, Sinclair G et al. Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care. 2010; 14(4):439-47.

Taylor D, Galan V, Weinstein SM, Reyes E, Pupo-Araya AR, Rauck. Fentanyl Pectin Nasal Spray in Breakthrough Cancer Pain. J Support Oncol. 2010; 8(4):184-90

Wedmore IS, Kotwal RS, McManus JG, Pennardt A, Talbot TS, Fowler M, et al. Safety and efficacy of oral transmucosal fentanyl citrate for prehospital pain control on the battlefield. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S490-5.

How to Cite
Payami S. The Efficacy of Fentanyl for Pain Management in Emergency Department: Review Article. Arch Anesth & Crit Care. 4(3):509-12.
Review Article(s)