FORT BRAGG, NC — Oral transmucosal fentanyl citrate (OTFC) is a rapid and noninvasive pain-management strategy that provides safe and effective analgesia in the pre-hospital battlefield setting, according to a new study.1
The authors of the report, which appeared in the Journal of Trauma and Acute Care Surgery, suggest, “OTFC has considerable implications for use in civilian pre-hospital and austere environments.”
The article’s background notes that acute pain resulting from trauma and other causes is a common condition requiring pre-hospital analgesia on and off the battlefield. During the past century, morphine is the narcotic most frequently used for pre-hospital analgesia on the battlefield. The problem is that intramuscular morphine has a delayed onset of pain relief that is suboptimal and also is difficult to titrate.
While intravenously administered morphine can readily provide rapid and effective pre-hospital analgesia, study authors note that OTFC is a safe alternative that does not require intravenous access and set out to investigate its safety and efficacy in the pre-hospital battlefield environment.
Researchers from the U.S. Army Austere and Wilderness Medicine Fellowship, Madigan Army Medical Center, Fort Bragg, NC, collected and analyzed data from March 15, 2003, to March 31, 2010, from combat deployments in Afghanistan and Iraq. Patients evaluated were U.S. Army Special Operations Command casualties receiving OTFC for acute pain. The verbal numeric rating scale (NRS) from 0 to 10 was used to quantify pretreatment and post-treatment pain intensities.
Of the 286 patients administered OTFC, 197 had NRS pain evaluations conducted before and approximately 15 minutes to 30 minutes following treatment.
Researchers found that the difference between NRS pain scores at 0 minutes (NRS, 8.0 [1.4]) and 15 minutes to 30 minutes (NRS, 3.2 [2.1]) was significant. Only 18.3% (36 of 197) of patients were also administered other types of analgesics.
Nausea, the most common adverse effect, was reported by 12.7% of patients.
Only a patient receiving the largest opioid dose, 3,200-µg OTFC and 20-mg morphine, had a major adverse effect, exhibiting hypoventilation and saturation of less than 90% requiring low-dose naloxone.
- Wedmore IS, Kotwal RS, McManus JG, Pennardt A, Talbot TS, Fowler M, McGhee L. Safety and efficacy of oral transmucosal fentanyl citrate for prehospital pain control on the battlefield. J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S490-5. doi: 10.1097/TA.0b013e3182754674. PubMed PMID: 23192075.