ClinicalTrials.gg
CompletedNCT06689124Updated Oct 2, 2026

A Randomized Study Comparing of Three Doses Nebulized Fentanyl in Older Adults

A Phase 3 interventional study of Nebulized fentanyl in Treatment Side Effects and Musculoskeletal Pain, sponsored by Bangkok Metropolitan Administration Medical College and Vajira Hospital. Completed at 2 sites in Thailand. Open to participants aged 65 Years to 99 Years. Per ClinicalTrials.gov, last updated 2026-10-02.

Sponsored by Bangkok Metropolitan Administration Medical College and Vajira Hospital · Phase 3, Interventional, and Treatment

Updated Oct 2, 2026Now CompletedResults publication added+5 moreGo to Updates ↓
Phase
Phase 3
Study type
Interventional
Enrollment
120
Allocation
Randomized
Ages
65 Years to 99 Years
Sex
All
01

Study summary

This clinical trial compares three different nebulized fentanyl dosages for older persons experiencing severe musculoskeletal pain at the emergency department.

The main objective is:

Does the effectiveness of nebulized fentanyl at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg at 30 minutes differ in older patients who report to the emergency room with pain from musculoskeletal injuries?

Secondary outcome are:

  1. Incidence of adverse effects after drug administration at minutes 0, 15, 30, 45, 60, 75, 90, 105, 120
  2. Incidence of receiving other pain relief treatments (rescue therapy) in minutes 30, 45, 60, 75, 90, 105, 120 Participants will receive an explanation of the study and possible side effects, which may take approximately 5-10 minutes, without affecting the primary treatment of the patients. Consent will be obtained in this study, along with signing or fingerprinting as evidence in the consent form.
Read the detailed description

Participants will receive nebulized fentanyl for pain reduction at the pre-determined randomized dose, then researchers will follow up assessments of pain levels, vital signs, and any side effects at various intervals.

02

Conditions studied

  • Treatment Side Effects
  • Musculoskeletal Pain

Keywords

  • fentanyl
  • opioid
  • nebulized
  • musculoskeletal pain
  • elderly
  • emergency room
  • randomized controlled trial
  • Thai
03

In context

Musculoskeletal Pain

515 studies on the registry are indexed under Musculoskeletal Pain; 127 are open to participants now.

This study's enrollment of 120 is above the median of 70 across 370 interventional studies indexed under Musculoskeletal Pain.

Browse Musculoskeletal Pain studies →

Lead sponsor

Bangkok Metropolitan Administration Medical College and Vajira Hospital is the lead sponsor of 23 studies on the registry; 1 is open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
65 Years to 99 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Age more than or equal 65 years old.
  • Presented with musculoskeletal pain within 3 days.
  • Pain score on verbal numeric rating scale ≥ 5.

Exclusion criteria

Exclusion Criteria:

  • Patients need immediate intervention.
  • Patients need acute rescue for acute coronary syndrome, respiratory failure, and stroke.
  • \< 30 ml/min, Cirrhosis stage III, IV (present with ascites and varices).
  • Trauma >2 organ.
  • Comorbidities of .
  • Take MAO inhibitors within 14 days.
  • History of opioid used within 8 hours.
  • History of alcohol or drug abuse.
  • History of fentanyl allergy.
  • Patients with difficulty to communication (e.g. altered mental status, severe dementia (define by 6-items cognitive screening > 12, language barrier).
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

COPD

Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Outcomes assessor)
Enrollment
120 participants (actual)

Study arms

  • Active comparator
    Nebulized fentanyl 2 mcg/kg

    The researcher prepared fentanyl (the researcher informed the in-charge nurse to open the medicine cabinet and double-checked the dosage with the in-charge nurse). The dosage was 2 micrograms per kilogram of body weight (calculated based on the patient's actual weight in kilograms). The medication was contained in a nebulizer. It was then mixed with normal saline (0.9% normal saline) to a total volume of 5 milliliters and administered via nebulization.

    Drug: Nebulized fentanyl

  • Active comparator
    Nebulized fentanyl 3 mcg/kg

    The researcher prepared fentanyl (the researcher informed the in-charge nurse to open the medicine cabinet and double-checked the dosage with the in-charge nurse). The dosage was 3 micrograms per kilogram of body weight (calculated based on the patient's actual weight in kilograms). The medication was contained in a nebulizer. It was then mixed with normal saline (0.9% normal saline) to a total volume of 5 milliliters and administered via nebulization.

    Drug: Nebulized fentanyl

  • Active comparator
    Nebulized fentanyl 4 mcg/kg

    The researcher prepared fentanyl (the researcher informed the in-charge nurse to open the medicine cabinet and double-checked the dosage with the in-charge nurse). The dosage was 4 micrograms per kilogram of body weight (calculated based on the patient's actual weight in kilograms). The medication was contained in a nebulizer. It was then mixed with normal saline (0.9% normal saline) to a total volume of 5 milliliters and administered via nebulization.

    Drug: Nebulized fentanyl

Interventions

  • After the enrollment process, the main research assistant will take a brown envelope containing the randomization and hand it to the principal investigator in numerical order. The principal investigator will then open the envelope to determine the group assignment for the patient, revealing which fentanyl nebulization dosage group (2 mcg/kg, 3 mcg/kg and 4 mcg/kg) the patient will be placed in. In this study, participants will be divided into three groups as previously described. We evaluate pain score at 0, 15, 30, 45, 60, 75, 90, 105 and 120 minutes after receiving nebulized fentanyl by a train research assistance who is blind from the treatment dosage.

    Also known as: Nebulized fentanyl dosage

06

What researchers measure

Primary outcomes

  1. Efficacy in pain reduction following nebulized fentanyl administration at different dosages.

    Efficacy in pain reduction following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with musculoskeletal pain, using verbal numerical rating scale (VNRS) VNRS score ranges from 0 to 10, with a higher score indicating more severe pain. Ten indicates the worst pain, and zero indicates no pain.

    Time frame: 30 Minutes

Secondary outcomes

  1. Adverse events following nebulized fentanyl administration at different dosages.

    Adverse events following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with with musculoskeletal pain

    Time frame: 0, 15, 30, 45, 60, 75, 90, 105, 120 Minutes

  2. Events of rescue therapy following nebulized fentanyl administration at different dosages.

    Events of rescue therapy following nebulized fentanyl administration at dosages of 2 mcg/kg, 3 mcg/kg, and 4 mcg/kg in elderly patients presenting to the emergency department with musculoskeletal pain

    Time frame: 30, 45, 60, 75, 90, 105, 120 Minutes

07

Study locations

2 sites
  • Faculty of Medicine,Vajira Hospital
    Bangkok, Bangkok 10300, Thailand
  • Jiraporn Sri-on
    Bangkok, Bangkok 10300, Thailand
08

References and documents

Publications

  • Chang HY, Daubresse M, Kruszewski SP, Alexander GC. Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med. 2014 May;32(5):421-31. doi: 10.1016/j.ajem.2014.01.015. Epub 2014 Jan 21. PubMed 24560834 ↗
  • Chakour MC, Gibson SJ, Bradbeer M, Helme RD. The effect of age on A delta- and C-fibre thermal pain perception. Pain. 1996 Jan;64(1):143-152. doi: 10.1016/0304-3959(95)00102-6. PubMed 8867257 ↗
  • Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001 Aug;17(3):457-78, vi. doi: 10.1016/s0749-0690(05)70080-x. PubMed 11459715 ↗
  • Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, Kress HG, Langford R, Likar R, Raffa RB, Sacerdote P. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008 Jul-Aug;8(4):287-313. doi: 10.1111/j.1533-2500.2008.00204.x. Epub 2008 May 23. PubMed 18503626 ↗
  • Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317-332. doi: 10.1016/S0304-3959(99)00242-0. PubMed 10781906 ↗
  • Teasell R, Dittmer DK. Complications of immobilization and bed rest. Part 2: Other complications. Can Fam Physician. 1993 Jun;39:1440-2, 1445-6. PubMed 8324412 ↗
  • Tongbua S, Sri-On J, Thong-On K, Paksophis T. Non-inferiority of intranasal ketamine compared to intravenous morphine for musculoskeletal pain relief among older adults in an emergency department: a randomised controlled trial. Age Ageing. 2022 Mar 1;51(3):afac073. doi: 10.1093/ageing/afac073. PubMed 35348606 ↗
  • Labroo RB, Paine MF, Thummel KE, Kharasch ED. Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implications for interindividual variability in disposition, efficacy, and drug interactions. Drug Metab Dispos. 1997 Sep;25(9):1072-80. PubMed 9311623 ↗
  • By the 2023 American Geriatrics Society Beers Criteria(R) Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023 Jul;71(7):2052-2081. doi: 10.1111/jgs.18372. Epub 2023 May 4. PubMed 37139824 ↗
  • Grape S, Schug SA, Lauer S, Schug BS. Formulations of fentanyl for the management of pain. Drugs. 2010;70(1):57-72. doi: 10.2165/11531740-000000000-00000. PubMed 20030425 ↗
  • Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008 Oct;16(5):405-16. doi: 10.1037/a0013628. PubMed 18837637 ↗
  • Farahmand S, Shiralizadeh S, Talebian MT, Bagheri-Hariri S, Arbab M, Basirghafouri H, Saeedi M, Sedaghat M, Mirzababai H. 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. PubMed 25027194 ↗
  • Sabri A, Szalas J, Holmes KS, Labib L, Mussivand T. Failed attempts and improvement strategies in peripheral intravenous catheterization. Biomed Mater Eng. 2013;23(1-2):93-108. doi: 10.3233/BME-120735. PubMed 23442240 ↗
  • Yalcinli S, Akarca FK, Can O, Sener A, Akbinar C. Factors affecting the first-attempt success rate of intravenous cannulation in older people. J Clin Nurs. 2019 Jun;28(11-12):2206-2213. doi: 10.1111/jocn.14816. Epub 2019 Mar 13. PubMed 30786094 ↗
  • Puntillo F, Giglio M, Varrassi G. The Routes of Administration for Acute Postoperative Pain Medication. Pain Ther. 2021 Dec;10(2):909-925. doi: 10.1007/s40122-021-00286-5. Epub 2021 Jul 17. PubMed 34273095 ↗
  • Thompson JP, Thompson DF. Nebulized Fentanyl in Acute Pain: A Systematic Review. Ann Pharmacother. 2016 Oct;50(10):882-91. doi: 10.1177/1060028016659077. Epub 2016 Jul 12. PubMed 27413071 ↗
  • Hess DR. Nebulizers: principles and performance. Respir Care. 2000 Jun;45(6):609-22. PubMed 10894454 ↗
  • Bartfield JM, Flint RD, McErlean M, Broderick J. Nebulized fentanyl for relief of abdominal pain. Acad Emerg Med. 2003 Mar;10(3):215-8. doi: 10.1111/j.1553-2712.2003.tb01993.x. PubMed 12615585 ↗
  • Miner JR, Kletti C, Herold M, Hubbard D, Biros MH. Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain. Acad Emerg Med. 2007 Oct;14(10):895-8. doi: 10.1197/j.aem.2007.06.036. PubMed 17898251 ↗
  • Singh AP, Jena SS, Meena RK, Tewari M, Rastogi V. Nebulised fentanyl for post-operative pain relief, a prospective double-blind controlled randomised clinical trial. Indian J Anaesth. 2013 Nov;57(6):583-6. doi: 10.4103/0019-5049.123331. PubMed 24403618 ↗
  • Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol. 2011 Mar;93(3):385-404. doi: 10.1016/j.pneurobio.2011.01.002. Epub 2011 Jan 7. PubMed 21216272 ↗
  • Li L, Liu X, Herr K. Postoperative pain intensity assessment: a comparison of four scales in Chinese adults. Pain Med. 2007 Apr;8(3):223-34. doi: 10.1111/j.1526-4637.2007.00296.x. PubMed 17371409 ↗
  • Singh V, Gillespie TW, Lane O, Spektor B, Zarrabi AJ, Egan K, Curseen K, Tsvetkova M, Beumer JH, Sniecinski R, Shteamer JW, Switchenko J, Harvey RD. A dose-escalation clinical trial of intranasal ketamine for uncontrolled cancer-related pain. Pharmacotherapy. 2022 Apr;42(4):298-310. doi: 10.1002/phar.2669. Epub 2022 Feb 21. PubMed 35146776 ↗
  • Imai K, Morita T, Yokomichi N, Mori M, Naito AS, Yamauchi T, Tsukuura H, Uneno Y, Tsuneto S, Inoue S. Association of the RASS Score with Intensity of Symptoms, Discomfort, and Communication Capacity in Terminally Ill Cancer Patients Receiving Palliative Sedation: Is RASS an Appropriate Outcome Measure? Palliat Med Rep. 2022 Apr 8;3(1):47-54. doi: 10.1089/pmr.2021.0087. eCollection 2022. PubMed 35558868 ↗

Individual participant data

Plan to share: No

09

Timeline

1 registry update since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedDate before it movedWhere the date was before it moved

Ran from Jul 2024 to primary completion in Jul 2025, 12 months.

Completion moved once since we started tracking on Sep 25, 2026: Jul 2025 → Dec 2025, on Oct 2, 2026.

Earlier changes are on the record history on ClinicalTrials.gov ↗

How these figures are worked out, and which studies are left out of them.

Registered
Jun 4, 2024
First posted
Nov 14, 2024
StartActual
Jul 1, 2024
Primary completionActual
Jul 1, 2025
CompletionActual
Dec 1, 2025was Jul 2025
Last update
Oct 2, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
Status
Active, not recruiting→Completed
changed Oct 2, 2026
Sites
2 sites added, 2 sites removed
Show 2 added (2 Thailand)
  • Faculty of Medicine,Vajira Hospital · Bangkok, Thailand
  • Jiraporn Sri-on · Bangkok, Thailand
Show 2 removed
  • Faculty of Medicine,Vajira Hospital · Bangkok, Thailand
  • Jiraporn Sri-on · Bangkok, Thailand
Oct 2, 2026
Study completion
Jul 1, 2025→Dec 1, 2025 (actual)
Oct 2, 2026
Publications
Results publication added: Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001 Aug;17(3):457-78, vi. doi: 10.1016/s0749-0690(05)70080-x. PubMed 11459715 ↗
Oct 2, 2026
Design
Not applicable→Phase 3
Oct 2, 2026
Show all 1 update
  1. Oct 2, 2026
    Active, not recruiting→Completed
    Publications Results publication added: Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001 Aug;17(3):457-78, vi. doi: 10.1016/s0749-0690(05)70080-x. PubMed 11459715 ↗
    2 sites added, 2 sites removed
    Show 2 added (2 Thailand)
    • Faculty of Medicine,Vajira Hospital · Bangkok, Thailand
    • Jiraporn Sri-on · Bangkok, Thailand
    Show 2 removed
    • Faculty of Medicine,Vajira Hospital · Bangkok, Thailand
    • Jiraporn Sri-on · Bangkok, Thailand
    Study completion Jul 1, 2025→Dec 1, 2025 (now actual)
    Design Not applicable→Phase 3
    + 3 other changes: identifiers, verification date and index terms

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT06689124
Lead sponsor
Bangkok Metropolitan Administration Medical College and Vajira Hospital
Collaborators
Navamindradhiraj University
Responsible party
Thananda Trakarnvanich (Doctor, Bangkok Metropolitan Administration Medical College and Vajira Hospital) — Principal investigator
First posted
Nov 14, 2024
Start date
Jul 1, 2024
Primary completion
Jul 1, 2025
Completion
Dec 1, 2025
Last update
Oct 2, 2026

Study contacts

Supavit Punyapatipan, M.D.
principal investigator · Faculty of medicine, Vajira hospital
Jiraporn Sri-on, M.D.
principal investigator · Faculty of medicine, Vajira hospital

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Fentanyl

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