Role of Intranasal Fentanyl in Pain Management for Sickle Cell Disease | ASH 2024
Researchers evaluated the safety, feasibility, and effectiveness of intranasal fentanyl in an adult population.
Intranasal fentanyl is safe, feasible, and effective in managing acute episodes of moderate to severe pain in patients with sickle cell disease, according to research results presented at the 66th American Society of Hematology Annual Meeting.1
Researchers evaluated the safety, feasibility, and effectiveness of intranasal fentanyl in an adult population. | Image credit: tassel78 - stock.adobe.com
Recommendations from both the American Society of Hematology and the National Heart, Lung, and Blood Institute recommend the rapid administration of opioid analgesia within 60 minutes of the onset of an acute pain episode. Intranasal fentanyl, with its noninvasive administration and rapid onset of less than 10 minutes, has been widely adopted in pediatric patients with sickle cell disease. However, there remains a lack of data supporting its use in adults.
Researchers from the Centre Hospitalier de l’Université de Montréal (CHUM) in Montréal, Canada conducted a retrospective chart review of 586 patients with sickle cell disease who received care between 2020 and 2024.
After identifying patients treated with intranasal fentanyl, the study population included 23 patients (74% women; median age, 26 years) with 38 visits who received intranasal fentanyl 100 mcg. Within this cohort, 66% of patients had HbSS, 21% had HbSC, and 13% had HbSβ+. Additionally, 86% of patients were receiving treatment with hydroxyurea and 21% were undergoing regular erythapheresis. All patients had previous exposure to opioid therapies, with 13% of patients having chronic exposure to long-acting opioids.
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At presentation, all 23 patients received co-analgesia with nonsteroidal anti-inflammatory drugs and subsequent parenteral opioids (median dose, 12.5 mg morphine equivalents; range, 5 mg-50 mg). Median time to administration of intranasal fentanyl was 48 minutes, with a range of 10 to 125 minutes, and median hospital stay duration was 4 hours (range, 1.5 to 6.7 hours).
Median pain score was 7 (range, 4-10) on presentation; at 1 hour following intranasal fentanyl administration and at discharge, median pain scores were 6 (range, 1-8) and 3 (range, 0-8), respectively, representing a median 60% reduction in pain score at the time of discharge (range, 0%-100%). Only 11% of visits—4 total—led to hospital admission as a result of inadequate pain control.
“To our knowledge, this is the first study reporting on the use of [intranasal fentanyl] in adults with [sickle cell disease]” in an outpatient hospital setting, the researchers wrote. “In this small cohort, [intranasal fentanyl] appeared to be feasible, safe, and effective in managing [acute pain episodes]…and was acceptable among patients.”
“Standardized protocols which incorporate [intranasal fentanyl] should therefore be considered in the management of adults with [sickle cell disease], and further research on its relative effectiveness compared to traditional parenteral routes of administration, as well as patient preferences, are needed,” they concluded.
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