Due to its non-invasive mode of
administration, intranasal (IN) application of drugs may be a valuable alternative to non-invasive
pain management. With characteristics that appear to be ideal for IN application, IN
fentanyl may have a place in the out-of-hospital treatment and the paediatric population. The objective of this systematic review was to evaluate the current evidence of IN
fentanyl in the treatment of
acute pain. Reports of randomized controlled trials (RCTs) of IN
fentanyl in treatment of
pain were systematically sought using the PubMed database, Embase, Google scholar, Cochrane database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered for inclusion if they were double-blinded randomized controlled trials (RCTs) of IN
fentanyl in the treatment of
acute pain. Thirty-two RCTs were identified, and 16 were included in the final analysis. No significant
analgesic differences between IN
fentanyl and intravenous (IV)
fentanyl were demonstrated in treatment of acute and
post-operative pain. Significant
analgesic effect of IN
fentanyl was demonstrated in the treatment of
breakthrough pain in
cancer patients. In the paediatric population, results demonstrated some
analgesic effect of IN
fentanyl following myringotomy, no
analgesic effect following voiding cystourethrography, and finally, no significant
analgesic difference after long
bone fractures, in
burns patients, and in
post-operative pain relief when compared to IV
morphine, oral
morphine, or IV
fentanyl, respectively. Significant
analgesic effect of IN
fentanyl was demonstrated in the treatment of
breakthrough pain in
cancer patients. However, the significant deficiencies in trials investigating acute and
post-operative pain, and the paediatric population makes firm recommendations impossible.