Intranasal Fentanyl for Pediatric Fracture Pain
Children treated with intranasal fentanyl had statistically significant reductions in pain scores.
Researchers prospectively evaluated the analgesic efficacy of atomized intranasal fentanyl (2 µg/kg; maximum dose, 100 µg) in 81 children (mean age, 8 years) who presented with clinically suspected fractures to a pediatric emergency department in Wisconsin. Eligible patients had moderate-to-severe pain according to scores on the Wong Baker Faces Scale (WBS) for children ages 3 to 8 years and a 100-mm visual analog scale (VAS) for children ages 9 to 18 years. The primary outcome measure was change in pain score at 10, 20, and 30 minutes. A significant response was defined as a decrease of one face on the WBS or 13 mm on the VAS.
Among 53 children ages 3 to 8 years, median WBS pain scores decreased significantly from five faces at baseline to three at 10 minutes and two at 20 and 30 minutes; 74% and 87% of patients, respectively, achieved clinically significant pain reduction at 10 and 30 minutes. Among 28 children ages 9 to 18 years, mean VAS pain scores decreased significantly (by 21–27 mm) at each time point, from a mean score of 70 mm at baseline; 69% and 61% of patients, respectively, achieved clinically significant pain reduction at 10 and 30 minutes.
Comment:
Intranasal fentanyl is rapid and effective and avoids venipuncture. As with all opioid analgesia, additional doses might be required to reach the desired endpoint.
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Katherine Bakes, MD
Published in Journal Watch Emergency Medicine December 10, 2010
Citation(s): Saunders M et al. Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain. Acad Emerg Med 2010 Nov; 17:1155.
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