{
  "abstract": "Background Despite analgesia being a cornerstone of humane trauma care, in situations where obtaining intravenous access proves difficult or too time-consuming, patients suffer from delays in analgesia. The Manchester Arena Inquiry identified this as a particular concern in mass-casualty incidents. Oral transmucosal fentanyl citrate (OTFC), also known as ‘fentanyl lozenges’, were highlighted as a potential solution. To date, no comprehensive review has focused on the use of pre-hospital OTFC. Given the recommendations of the Manchester Arena Inquiry, this rapid evidence review will urgently synthesise evidence on the safety and efficacy of OTFC in the management of pre-hospital pain.Methods A rapid evidence review with narrative synthesis and meta-analysis was performed. Three databases (Embase, MEDLINE complete, and CINAHL Complete) were searched on the 13th May 2025. Studies were eligible for inclusion if they were peer-reviewed trials or observational studies examining the use of OTFC for acute pain management in pre-hospital settings. Eligible studies had to report on at least one of the following: efficacy, safety, time to analgesic onset, or patient/provider experience. Studies were excluded if they were non-peer reviewed, in-hospital, did not include relevant outcome data, or were non-English language.Results Five cohort studies were included in the final review. They are of varying qualities and display significant heterogeneity. A meta-analysis, including 410 participants across four studies, found a mean reduction in reported pain score of 3.86 (95% CI [2.53; 5.20], I2 = 98.4%). Narrative synthesis showed that all studies reported a clinically meaningful reduction in pain scores, minimal serious adverse events, and mild side-effects.Conclusion OTFC is an effective and generally safe form of analgesia in the context of pre-hospital pain. Given its ease of administration and rapid onset, it represents a promising option - particularly in situations where IV access is delayed, difficult, or not possible.",
  "authors": [
    {
      "affiliations": [
        "Yorkshire Ambulance Service NHS Trust, UK"
      ],
      "name": "Cameron Barcroft"
    },
    {
      "affiliations": [
        "Mid Yorkshire Teaching NHS Trust, UK"
      ],
      "name": "Lucy Pangbourne"
    }
  ],
  "title": "PP20 The safety and efficacy of oral transmucosal fentanyl citrate in the management of pre-hospital pain – a rapid evidence review with meta-analysis",
  "uid": "f3133252-e5ca-5ec9-9936-0f1887e53605"
}