ministered with a MAD Nasal (Wolfe Tory Medical Inc, Salt Lake City, UT) mucosal atomizing device. Doses were administered in 1/6 dose increments in alternating nares. Pain scores were recorded at 0, 2, 5, and 10 minutes using a verbally administered numerical rating scale of 0 through 10.
Results.-Data analysis was performed using results from 42 of the 46 patients: 5 pediatric and 37 adult. Four patients were excluded due to incomplete data. Thirty-four patients were initially treated on-slope and 8 patients were initially treated in the clinic. Average weight-based dosage for intranasal fentanyl was 1.4 g/kg (95% confidence interval [CI]: 1.3-1.5 g/kg; n ϭ 42). The mean baseline pain score for all patients was 8.2 (95% CI: 7.7-8.7; n ϭ 42). Pain scores were significantly reduced after treatment with fentanyl. Mean pain score reduction at 2 minutes was Ϫ1.4 (95% CI: Ϫ2.0 to Ϫ0.96; n ϭ 41); at 5 minutes, Ϫ2.8 (95% CI: Ϫ3.5 to Ϫ2.1; nϭ42); at 10 minutes, Ϫ2.8 (95% CI: Ϫ3.7 to Ϫ1.9; n ϭ 29). No significant complications were noted.
Conclusion.-Intranasal fentanyl provides effective analgesia in acutely injured patients and is a good option for patients in whom immediate intravenous access is complicated by environmental, anatomic, or resource limitations. The potential application for search-and-rescue and other austere medicine situations is widespread.