Instanyl (fentanyl) / Takeda - LARVOL DELTA

A BREATHLESS HIGH: ARDS FOLLOWING INTRANASAL FENTANYL USE (CHEST 2026) - No abstract available

Acute Lung Injury • Acute Respiratory Distress Syndrome • Critical care • Respiratory Diseases

Inhaled Methoxyflurane in Australian Emergency Departments-A Cost-Minimisation Analysis. (PubMed, Emerg Med Australas) - "Broader use of methoxyflurane for the management of pain and minor procedures in Australian EDs could deliver meaningful operational efficiency gains."

HEOR • Journal • Anesthesia • Musculoskeletal Diseases • Orthopedics • Pain • Thermal Injury

Acute Pain Management in Children: A Systematic Review and GRADE-Based Recommendations. (PubMed, J Clin Med) - "Intranasal fentanyl appeared comparable to intravenous morphine and more feasible in emergency settings...Paracetamol and ibuprofen remain first-line treatments for mild-to-moderate pain, with possible context-specific benefits of ibuprofen or combination therapy. Non-pharmacological interventions may be useful adjuncts, especially for anxiety and procedural distress. Further high-quality studies are needed on opioids, intranasal administration, alternating regimens, and inhaled versus topical analgesia."

Journal • Review • Mood Disorders • Pain • Pediatrics • Psychiatry

A randomised controlled trial of interventions to reduce the pain and distress of nasogastric tube insertion in young children. (ANZCTR) - P=N/A | N=530 | Recruiting | Sponsor: Monash University | Not yet recruiting ➔ Recruiting

Enrollment open • Pain

Intranasal fentanyl to reduce pain intensity associated with retinopathy of prematurity screening in preterm infants: study protocol for a randomized controlled trial. (PubMed, BMC Pediatr) - P1/2 | "This trial will provide high-quality evidence regarding the effectiveness and safety of intranasal fentanyl for procedural pain relief during ROP screening in preterm infants. Findings may inform future clinical guidelines and contribute to improved pain management practices for this population."

Clinical • Journal • Anesthesia • Critical care • Pain • Retinal Disorders • Retinopathy of Prematurity

Establishing an efficacy hierarchy for breakthrough cancer pain management: a network meta-analysis of rapid-onset fentanyl formulations and morphine. (PubMed, BMC Med) - "This analysis provides evidence for a relative efficacy hierarchy among rapid-onset opioids for BTP. INFS demonstrated the most rapid and sustained analgesia across all evaluated time points, while FBT consistently ranked second. The delayed onset of MSIR warrants consideration when selecting agents for rapid pain relief. Treatment selection should integrate these efficacy data with safety profiles, route feasibility, and patient-specific factors."

Journal • Retrospective data • Oncology • Pain

FIREFLY: Fentanyl Intranasal for Retinopathy of Prematurity Screening in Preterm Infants (clinicaltrials.gov) - P1/2 | N=58 | Not yet recruiting | Sponsor: Marsha Campbell-Yeo | Trial completion date: May 2027 ➔ Jun 2028 | Initiation date: Oct 2025 ➔ Sep 2026 | Trial primary completion date: Oct 2026 ➔ Mar 2028

Trial completion date • Trial initiation date • Trial primary completion date • Critical care • Pain • Retinal Disorders • Retinopathy of Prematurity

Atypical Stercoral Colitis in Chronic Opioid Use With Concurrent Hepatic and Pulmonary Lesions. (PubMed, Cureus) - "A 72-year-old woman with chronic intranasal fentanyl use presented with localized rectal pain and overflow diarrhea. Recognizing overflow diarrhea is critical to avoid inappropriate anti-motility therapy, which carries a high risk of colonic perforation in the setting of SC. Early cross-sectional imaging and prioritization of reversible causes are essential when managing such complex, multisystem presentations."

Journal • Constipation • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Infectious Disease • Oncology • Pain

Case Report: Oral-Nasal Damage in a Person Using Fentanyl and Xylazine. (PubMed, J Addict Med) - "This case illustrates damage to the nose, palate, and skull base, likely secondary to co-use of fentanyl and xylazine intranasally. It is important for clinicians to recognize that nasal damage may result from fentanyl and xylazine use and refer to appropriate substance use disorder and otolaryngology treatment to prevent further destruction."

Journal • Otorhinolaryngology • Substance Abuse

Early vs delayed opioid administration for pediatric sickle cell vaso-occlusive crisis: A systematic review and meta-analysis. (PubMed, Am J Emerg Med) - "Our analysis showed no difference comparing early and delayed opioid administration in pediatric patients with sickle cell related VOE across hospital admission, ED discharge, ED length of stay, and pain reassessment."

Journal • Retrospective data • Addiction (Opioid and Alcohol) • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Rapid Relief of Breathlessness with Fast-Acting Opioids and Benzodiazepines: A Systematic Review. (PubMed, J Pain Symptom Manage) - "Instead of use as routine care, fast-acting opioids (morphine subcutaneous or intravenous) should be considered as a second step if non-pharmacological measures have failed. Further research is needed, especially for other centrally acting drugs and adverse effects."

Journal • Review • CNS Disorders • Palliative care

Safety and Efficacy of Intranasal Fentanyl Use in Early Infancy: A Single-Center Experience (PAS 2026) - "Concomitant sedatives included midazolam (34%), morphine (9.4%), IV fentanyl (3.8%), vecuronium (3.8%), and lorazepam (1.9%). Out of 9,965 infants, 40 (0.4%) received 53 INF doses (mean = 1.4 ± 0.45 µg/kg), with increasing use over time (Figure 1B); recipient characteristics are shown in Figure 1A. Most infants (82.5%) lacked IV access at administration. The primary indications were peripherally inserted central catheter (PICC) placement (47.2%) and intubation (32.1%) (Figure 2)."

Clinical

Effectiveness and safety of intranasal fentanyl for pain management in infants aged 0-6 months of age: a systematic review. (PubMed, JBI Evid Synth) - "Intranasal fentanyl may reduce procedural pain in stable preterm infants with no serious safety concerns. However, the findings were based on 2 small trials with methodological limitations and moderate risk of bias. Further high-quality research is needed to confirm the efficacy, optimize dosing, and assess the safety in broader infant populations."

Journal • Anesthesia • Pain • Retinal Disorders • Retinopathy of Prematurity

Study of topical anaesthetic for paediatric laser procedures (STAPLE): a protocol for a feasibility and pilot randomised controlled trial. (PubMed, BMJ Open) - P2 | "Patients will be randomised in a 1:1 ratio to receive either TA cream (lidocaine 2.5%/prilocaine 2.5% (Numit 5% cream, Ego Pharmaceuticals, Braeside, VIC, Australia)) or a placebo, along with our unit's standard multimodal analgesic agents for laser treatment (including paracetamol, ibuprofen or oxycodone and intraprocedural sucrose solution or intranasal fentanyl). Participating families that have indicated an interest in trial results will receive a plain-language summary of the trial results by email. ACTRN12623000494639."

Clinical protocol • Journal • Anesthesia • Pain • Pediatrics

Decreasing Door-to-Analgesia Time: Increasing Use of Sickle Cell Pain Management Pathway. (PubMed, J Emerg Nurs) - "This quality improvement initiative demonstrated that increased use of a pre-established intranasal fentaNYL protocol yielded a reduction in time to opioid administration for pediatric patients with sickle cell disease in vaso-occlusive crises. These results align with existing literature emphasizing the benefits of standardized pain pathways in improving efficiency and equity in practice."

Journal • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Pediatric procedural sedation and analgesia in the emergency setting in community hospitals in Italy: current status and challenges. (PubMed, Ital J Pediatr) - "Despite staff awareness about the importance of pediatric procedural sedation/analgesia, lack of specific knowledge and training, as well as limited availability of sedative/analgesic medications represent current challenges to procedural sedation implementation in community hospitals without a pediatric emergency room."

Journal • Anesthesia • Mood Disorders • Pain • Pediatrics • Psychiatry

Practice-Change Pathway to Reduce Procedural Distress During Intussusception Reduction-A Quality Improvement Initiative. (PubMed, Pediatr Emerg Care) - "This QI initiative improved rates of analgesic and anxiolytic provision to reduce distress in patients undergoing intussusception reduction, without adverse outcomes. This project highlights the effectiveness of structured interventions in optimizing pediatric procedural pain management and potentially serves as a model for spread to other pediatric emergency departments."

Journal • Anesthesia • Gastrointestinal Disorder • Pain • Pediatrics

Comparison of inhalational methoxyflurane, intranasal fentanyl, and intravenous morphine for treatment of prehospital acute pain in Norway (PreMeFen): a randomised, non-inferiority, three-arm, phase 3 trial. (PubMed, Lancet) - P3 | "Inhalational methoxyflurane is non-inferior to intranasal fentanyl and intravenous morphine for acute pain management in the prehospital environment, assessed 10 min after administration. Inhalational methoxyflurane serves as a valuable non-intravenous alternative in the early phase of treatment and might bridge the gap to longer-acting analgesics."

Head-to-Head • Journal • P3 data • CNS Disorders • Depression • Pain • Psychiatry

Standardized Clinical Pathways Improve Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department (ASH 2023) - "A total of 0 (0%) hydromorphone PCAs were administered in the ED in the pre-pathway cohort compared to 4 (3.8%) hydromorphone PCA administered in the ED in the post-pathway cohort... Standardizing pain management using a clinical pathway has shown improvement in ED management of VOE in the first year post implementation with increased utilization of intranasal fentanyl and PCAs. Our goal of increased percentage of patients receiving pain medication within 30 minutes and decreased time to first analgesic was not achieved, however this is an ongoing project and with education in implementation of the clinical pathway we hope to continue to see long term progress. Additionally, in the future, we plan to expand use of this pathway to additional sites within our health care system."

Clinical • Anesthesia • Genetic Disorders • Hematological Disorders • Pediatrics • Sickle Cell Disease

Variability in Internal Algorithms for Sickle Cell Disease (ASH 2024) - "Intranasal fentanyl was recommended by 31 algorithms, with individualized pain protocol and non-pharmacological measures mentioned in 19 each. Despite technical challenges, most protocols recommended exchange transfusion for severe ACS, in line with national guidelines.Conclusion : Despite the presence of national guidelines, internal algorithms for VOC and ACS in pediatric SCD show great variability, likely due to the lack of robust evidence supporting specific recommendations in national guidelines. Prospective studies are crucial to fill these evidence gaps with the overall goal of improving patient care."

Genetic Disorders • Hematological Disorders • Pediatrics • Sickle Cell Disease

Improving the Care of Adults with Sickle Cell Disease in a Large Tertiary Hospital Emergency Department By Incorporating Patients' and Providers' Feedback (ASH 2024) - "Our goal is to increase the percentage of all patients who receive opioids within 60 minutes from 19.1% to at least 50% by December 2025.Priority change ideas include ongoing nurse training in port access and the use of vein-finding ultrasounds, staff education on VOC management, subcutaneous opioid administration or intranasal fentanyl to reduce opioid wait times, and the integration of individualized pain plans into medical records. Data are being collected with the help of information technology to assess trends.We strongly recommend the assessment of opioid wait times as an essential ED QI measure. Both patients' and providers' opinions should be considered when developing plan-do-study-act cycles (PDSA) and change ideas."

Clinical • Genetic Disorders • Hematological Disorders • Sickle Cell Disease

Feasibility, Safety and Effectiveness of Intranasal Fentanyl in the Treatment of Acute Pain Episodes Among Adults with Sickle Cell Disease: A Retrospective Single Center Study (ASH 2024) - "Twenty (86%) patients were receiving treatment with hydroxyurea, and 5 (21%) were undergoing regular erythrapheresis...On presentation, all patients received co-analgesia with non-steroidal anti-inflammatory drugs, and all received subsequent doses of parenteral opioids, with a median dose of 12.5 mg (5-50 mg) morphine equivalents...The use of INF has been widely accepted in the pediatric population with SCD and it has been shown to be effective in adults with chronic and cancer related pain. Standardized protocols which incorporate INF should therefore be considered in the management of adults with SCD, and further research on its relative effectiveness compared to traditional parenteral routes of administration, as well as patient preferences, are needed."

Retrospective data • Cardiovascular • CNS Disorders • Depression • Dermatology • Genetic Disorders • Hematological Disorders • Hypotension • Pain • Pediatrics • Pruritus • Psychiatry • Sickle Cell Disease

Intranasal Fentanyl and the Impact of an Emergency Department Pain Protocol on Hospital Admission Rates (ASH 2024) - "Our study illustrated the significant impact a standardized treatment algorithm created with a multidisciplinary group of champions can have on time to the first dose of analgesia and outcomes such as hospitalization rates, suggesting improved pain management. Future work will be focused on understanding how these systems and clinical improvements translate to patient experience and patient-reported outcomes."

Clinical • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Intranasal Fentanyl and Impact of an Emergency Department Pain Protocol for Sickle Cell Disease on Hospitalization Rates. (PubMed, Blood Adv) - "Implementing a standardized ED SCD pain protocol improved timeliness and consistency in analgesia administration and decreased overall hospitalization rates. This study also highlights the role of INF as an effective initial analgesic within standardized ED protocols for pediatric VOC."

Journal • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Feasibility, safety and efficacy of intranasal fentanyl in the treatment of acute pain episodes among adults with sickle cell disease: A retrospective single-centre study. (PubMed, Br J Haematol) - No abstract available

Journal • Retrospective data • Genetic Disorders • Hematological Disorders • Pain • Sickle Cell Disease