Intranasal Fentanyl as an Adjunct to Lidocaine Infiltration in Adults Undergoing Abscess Incision and Drainage

Inclusion Criteria: * Presenting to the ED for an abscess requiring incision and drainage * ED attending physician's judgment that the patient has capacity to provide informed consent. * Patients must be able to understand English or Spanish. Exclusion Criteria: * Use of opioids or tramadol within past 7 days. * Prior adverse reaction or allergy to opioids. * Patients who are pregnant * Patients weight \> 100kg * Chronic pain syndrome: frequently recurrent or daily pain for at least 3 months results in modulation of pain perception which is thought to be due to down-regulation of pain receptors. Examples of chronic pain syndromes include sickle cell anemia, osteoarthritis, fibromyalgia, and peripheral neuropathies. * Medical condition that might affect metabolism or opioid analgesics such as cirrhosis (Child Pugh A or worse) or kidney impairment (CKD 3 or worse) * Chronic malnutrition, severe hypovolemia (dehydration of blood loss) or hepatic disease * Alcohol intoxication: history of alcoholism or the presence of alcohol intoxication as judged by the treating physician may alter pain perception and has previously increased adverse events. * SBP \<100 mmHg: Opioids can produce peripheral vasodilation causing orthostasis. * HR \< 60/min: Opioids can cause bradycardia. * Oxygen saturation \< 95% on room air: For this study, oxygen saturation must be 95% or above on room air in order to be enrolled. * Use of MAO inhibitors in past 30 days: MAO inhibitors have been reported to intensify the effects of at least one opioid drug causing anxiety, confusion and significant respiratory depression or coma. * Patients using transdermal pain patches or oral opioid use \> 10 days in the prior month: frequent opioid use may influence both the amount of pain patients report as well as the level of relief they obtain from other treatments. * Patients with a history of traumatic brain injury, seizures or hallucinations * Patients with anatomical anomalies or medical conditions precluding intranasal administration