Intranasal Fentanyl as an Adjunct to Lidocaine Infiltration in Adults Undergoing Abscess Incision and Drainage

Exclusion Criteria

• •Use of opioids or tramadol within past 7 days.
• •Prior adverse reaction or allergy to opioids.
• •Patients who are pregnant
• •Patients weight \> 100kg
• •Chronic pain syndrome: frequently recurrent or daily pain for at least 3 months results in modulation of pain perception which is thought to be due to down-regulation of pain receptors. Examples of chronic pain syndromes include sickle cell anemia, osteoarthritis, fibromyalgia, and peripheral neuropathies.
• •Medical condition that might affect metabolism or opioid analgesics such as cirrhosis (Child Pugh A or worse) or kidney impairment (CKD 3 or worse)
• •Chronic malnutrition, severe hypovolemia (dehydration of blood loss) or hepatic disease
• •Alcohol intoxication: history of alcoholism or the presence of alcohol intoxication as judged by the treating physician may alter pain perception and has previously increased adverse events.
• •SBP \<100 mmHg: Opioids can produce peripheral vasodilation causing orthostasis.
• •HR \< 60/min: Opioids can cause bradycardia.
• •Oxygen saturation \< 95% on room air: For this study, oxygen saturation must be 95% or above on room air in order to be enrolled.
• •Use of MAO inhibitors in past 30 days: MAO inhibitors have been reported to intensify the effects of at least one opioid drug causing anxiety, confusion and significant respiratory depression or coma.
• •Patients using transdermal pain patches or oral opioid use \> 10 days in the prior month: frequent opioid use may influence both the amount of pain patients report as well as the level of relief they obtain from other treatments.
• •Patients with a history of traumatic brain injury, seizures or hallucinations
• •Patients with anatomical anomalies or medical conditions precluding intranasal administration