Pearl of the day - Nebulized Analgesia

To paraphrase Dr. Sergey Motov: when IV access is unattainable or undesirable, nebulized, intranasal and transmucosal administration of analgesics should be considered for acute pain management in the ED. The best evidence is from a systematic review of nebulized fentanyl (see citation).

The doses (off-label use) are: 4mcg/kg for an adult titrated up to three doses. Peds: 2-4mcg/kg. For morphine: 0.2mg/kg peds, 10mg or 20mg adults fixed-dose.

We can use the breath-actuated nebulizer (pic) to ensure patient-controlled dosing. It is located in the pyxis or from pharmacy. If you still don’t know how to use it, ask!

Manufacturer video:

See this article for more information:

Thompson JP, Thompson DF. Nebulized Fentanyl in Acute Pain: A Systematic Review. Annals of Pharmacotherapy 2016, Vol 50(10): 882-891.