Analgesic Effect of Nebulized Versus Intravenous Fentanyl for Pain Relief of Limb Fracture: A Double-Blind Clinical Trial

Mohammadreza Maleki Verki, Kambiz Masoumi*, Hassan Motamed, Meisam Moezi, Arash Forouzan, Ala Bahrami
Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

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© 2017 Verki et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Tel: +986132229166, Fax: +986132229166; Emails:;



More than half of the patients attending emergency centers need analgesics. Injectable analgesics are currently the most common pain control strategy, but entail complications. Fentanyl is one of the most commonly used pain-relief opiates available in various forms.


The present study aims to compare analgesic effects of nebulized against intravenous fentanyl for controlling pain due to limb fracture.


The present double-blind clinical trial recruited 213 patients presenting with fractured limbs to emergency departments. The first group of patients received 1 micg/kg of intravenous fentanyl citrate from a solution of 50 micg/ml and 5 ml of normal saline in nebulized form (group A), and the second group intravenously received 5 ml of normal saline and 4 micg/kg of 50 micg/ml solution of fentanyl citrate in nebulized form, whose volume reached 5 ml with the addition of normal saline (group B). Then, pain level was frequently measured and compared in the two groups for 20 minutes.


The results obtained showed reduced pain level in both the groups. However, point-by-point comparison of pain in the two groups revealed significantly greater pain reduction in intravenous fentanyl group (P<0.001). The need for adjuvant pain relief medication was 8.3% in intravenous fentanyl group and 24% in nebulized fentanyl group, with a significant difference between the two groups (P=0.002).


According to the results, although nebulized fentanyl is effective in controlling pain due to limb fracture, it was less effective than intravenous type, and unable to control pain in many cases.

Keywords: Fentanyl, Intravenous, Nebulized, Limb Fracture.