Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: a randomized clinical trial

Am J Emerg Med. 2014 Sep;32(9):1011-5. doi: 10.1016/j.ajem.2014.05.051. Epub 2014 Jun 12.


Objective: Intravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain.

Methods: This was a placebo-controlled, double-blind randomized clinical trial. Ninety emergency department patients with moderate to severe pain aged 15 to 50 years were blocked randomized and enrolled in this study. Forty-seven patients in the experimental group received nebulized fentanyl (4 μg/kg) and IV normal saline as placebo, and the remaining 43 patients in the control group received IV morphine (0.1 mg/kg) and nebulized normal saline as placebo. All participants' pain scores were assessed by Numerical Rating Scale before and after intervention at 5-, 10-, 15-, 30-, 45-, and 60-minute intervals. Patients' vital sign and possible adverse effects were recorded respectively. Finally, all participants were assessed for their satisfaction.

Results: The mean initial pain score in the experimental group was 8.7 and 8.4 in the control group (P = .1). Pain relief in both groups after 5 and 10 minutes were similar (P = .72). Although the pain relief was significantly greater with fentanyl at 15 minutes, this difference is not clinically significant. Pain management in both groups was successful and was more than 3 scores reduction in Numerical Rating Scale. Patient satisfaction in both groups was similar. No adverse effects were reported in the experimental group.

Conclusion: This study suggests that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Pain / drug therapy*
  • Administration, Inhalation
  • Adult
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Arm Injuries / drug therapy*
  • Double-Blind Method
  • Emergency Service, Hospital*
  • Female
  • Fentanyl / administration & dosage
  • Fentanyl / therapeutic use*
  • Humans
  • Injections, Intravenous
  • Leg Injuries / drug therapy*
  • Male
  • Morphine / administration & dosage
  • Morphine / therapeutic use*
  • Pain Measurement
  • Patient Satisfaction
  • Time Factors


  • Analgesics, Opioid
  • Morphine
  • Fentanyl