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.
Intranasal fentanyl is rapid and effective and avoids venipuncture. As with all opioid analgesia, additional doses might be required to reach the desired endpoint.
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.