Review of: Borland M, Jacobs I, King B, et al: “A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department.” Annals of Emergency Medicine. 49(3):335-340, 2007
This study was a double-blind placebo controlled comparison of IV morphine versus intranasal fentanyl to provide analgesia in children with obvious long bone injuries. The dose of morphine and fentanyl was 0.1 mg/kg and 1.7 mcg/kg respectively.
They found no significant difference in visual analogue pain scores at five, 10, 20 or 30 minutes after administration. The authors therefore concluded that intranasal fentanyl is equivalent to intravenous morphine in these subjects.
Pain management should be a primary concern not only for the emergency department (ED) but for EMS as well. Previous studies have shown that EMS, even with IV morphine, fails miserably in providing analgesia to children. I suspect this failure is based on a reluctance of starting an intravenous line in terrified, young patients due to its inherent difficulties.
With the increased use of fentanyl by EMS – and the knowledge provided by this study – hopefully someone will study the feasibility of providing intranasal fentanyl to injured children. While intranasal administration of fentanyl is not FDA approved, that shouldn’t stop us from exploring the appropriateness of its use. Our patients, young and old, deserve pain relief. That is the number one reason they call us, isn t it?