A Randomized Study Comparing of Three Doses Nebulized Fentanyl in Older Adults

N/AActive Not RecruitingNCT06689124

Bangkok Metropolitan Administration Medical College and Vajira Hospital120 enrolled

Overview

This clinical trial compares three different nebulized fentanyl dosages for older persons experiencing severe musculoskeletal pain at the emergency department. The main objective is: Does the effectiveness of nebulized fentanyl at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg at 30 minutes differ in older patients who report to the emergency room with pain from musculoskeletal injuries? Secondary outcome are: 1. Incidence of adverse effects after drug administration at minutes 0, 15, 30, 45, 60, 75, 90, 105, 120 2. Incidence of receiving other pain relief treatments (rescue therapy) in minutes 30, 45, 60, 75, 90, 105, 120 Participants will receive an explanation of the study and possible side effects, which may take approximately 5-10 minutes, without affecting the primary treatment of the patients. Consent will be obtained in this study, along with signing or fingerprinting as evidence in the consent form.

Participants will receive nebulized fentanyl for pain reduction at the pre-determined randomized dose, then researchers will follow up assessments of pain levels, vital signs, and any side effects at various intervals.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

120

Conditions

Treatment Side Effects Musculoskeletal Pain

Interventions

Nebulized fentanylDRUG

After the enrollment process, the main research assistant will take a brown envelope containing the randomization and hand it to the principal investigator in numerical order. The principal investigator will then open the envelope to determine the group assignment for the patient, revealing which fentanyl nebulization dosage group (2 mcg/kg, 3 mcg/kg and 4 mcg/kg) the patient will be placed in. In this study, participants will be divided into three groups as previously described. We evaluate pain score at 0, 15, 30, 45, 60, 75, 90, 105 and 120 minutes after receiving nebulized fentanyl by a train research assistance who is blind from the treatment dosage.

Eligibility

Sex: ALLMin age: 65 YearsMax age: 99 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age more than or equal 65 years old. * Presented with musculoskeletal pain within 3 days. * Pain score on verbal numeric rating scale ≥ 5. Exclusion Criteria: * Patients need immediate intervention. * Patients need acute rescue for acute coronary syndrome, respiratory failure, and stroke. * Creatinine clearance \< 30 ml/min, Cirrhosis stage III, IV (present with ascites and varices). * Trauma \>2 organ. * Comorbidities of chronic obstructive pulmonary disease. * Take MAO inhibitors within 14 days. * History of opioid used within 8 hours. * History of alcohol or drug abuse. * History of fentanyl allergy. * Patients with difficulty to communication (e.g. altered mental status, severe dementia (define by 6-items cognitive screening \> 12, language barrier).

Outcomes

Primary Outcomes

Efficacy in pain reduction following nebulized fentanyl administration at different dosages.

Efficacy in pain reduction following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with musculoskeletal pain, using verbal numerical rating scale (VNRS) VNRS score ranges from 0 to 10, with a higher score indicating more severe pain. Ten indicates the worst pain, and zero indicates no pain.

Time frame: 30 Minutes

Secondary Outcomes

Adverse events following nebulized fentanyl administration at different dosages.

Adverse events following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with with musculoskeletal pain

Time frame: 0, 15, 30, 45, 60, 75, 90, 105, 120 Minutes

Events of rescue therapy following nebulized fentanyl administration at different dosages.

Events of rescue therapy following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with musculoskeletal pain

Time frame: 30, 45, 60, 75, 90, 105, 120 Minutes