Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway.

OBJECTIVE: This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

METHODS: A pain pathway for IN fentanyl in long-bone fractures was instituted in our ED in July 2011. We performed a retrospective and prospective chart review of patients aged 3 to 21 years who presented to the ED with a clinically suspected long-bone fracture and either received IV morphine or were placed on IN fentanyl pain pathway.

RESULTS: A total of 94 patients met our inclusion criteria; 71 received IV morphine, and 23 received IN fentanyl, per pathway protocol. The mean length of time to pain medication administration was statistically significantly faster for IN fentanyl (37 minutes) than for IV morphine (62 minutes) (P = 0.002). The mean total length of stay for patients who received IN fentanyl versus patients who received IV morphine was not statistically significantly different after excluding patients who needed reduction or surgery. Effectiveness of pain control was not statistically significantly different between the IN fentanyl group and the IV morphine group.

CONCLUSIONS: Use of the IN fentanyl pain pathway significantly decreases time to pain medication administration in pediatric patients with suspected long-bone fractures.