Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 335-340 , March 2007

A Randomized Controlled Trial Comparing Intranasal Fentanyl to Intravenous Morphine for Managing Acute Pain in Children in the Emergency Department

Presented at the Australasian College for Emergency Medicine annual scientific meeting, Melbourne, Australia, November 2005.

  • Meredith Borland, MBBS, FACEM

      Affiliations

    • Princess Margaret Hospital for Children, Subiaco (Borland, King)
    • Corresponding Author InformationAddress for correspondence: Meredith Borland, MBBS, FACEM, GPO Box D184, Perth WA 6840, Australia; 61-(0)-8-9340-8222, fax 61-(0)-8-9340-8118
    • ,
  • Ian Jacobs, PhD, FRCNA

      Affiliations

    • Discipline of Emergency Medicine, University of Western Australia, Perth (Jacobs)
    • ,
  • Barbara King, MBBS, FRACP

      Affiliations

    • Princess Margaret Hospital for Children, Subiaco (Borland, King)
    • School of Paediatrics and Child Health, University of Western Australia, Perth (King)
    • ,
  • Debra O'Brien, MBBS, FACEM

      Affiliations

    • Emergency Department, Sir Charles Gairdner Hospital, Nedlands (O'Brien) WA, Australia

Received 6 January 2006 ,Revised 31 May 2006 ,Accepted 8 June 2006.

References 

  1. Simpson N, Finlay F. Only one fifth of A&E departments were found to have pain control policy for children [letter]. BMJ. 1998;316:396
  2. Friedland LR, Pancioli AM, Duncan KM. Pediatric emergency department analgesic practice. Pediatr Emerg Care. 1997;13:103–106
  3. Brent A. The management of pain in the emergency department. Pediatr Clin North Am. 2000;47:651–679
  4. Kennedy RM, Luhmann JD. The “ouchless emergency department” getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am. 1999;46:1215–1247
  5. Younge PA, Nicol MF, Kendall JM, et al. A prospective randomised pilot comparison of intranasal fentanyl and intramuscular morphine for analgesia in children presenting to the emergency department with clinical fractures. Emerg Med (Fremantle). 1999;11:90–94
  6. Kendall JM, Reeves BC, Latter VS. Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures. BMJ. 2001;322:261–265
  7. Manjushree R, Lahiri A, Ghosh BR, et al. Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients. Can J Anesth. 2002;49:190–193
  8. Borland ML, Jacobs I, Geelhoed G. Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Emerg Med (Fremantle). 2002;14:275–280
  9. Striebel HW, Pommerening J, Rieger A. Intranasal fentanyl titration for postoperative pain management in an unselected population. Anaesthesia. 1993;48:753–757
  10. NHMRC Guidelines for Ethical Research 1999. Commonwealth of Australia Canberra.
  11. Lim CB, Paech MJ, Sunderland VB, et al. Pharmacokinetics of nasal fentanyl. J Pharm Pract Res. 2003;33:59–63
  12. Powell CV, Kelly A-M, Williams A. Determining the minimum clinically significant difference in visual analog pain score for children. Ann Emerg Med. 2001;37:28–31
  13. Todd KH, Funk KG, Funk JP, et al. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27:485–489
  14. Ho K, Spence J, Murphy MF. Review of pain-measurement tools. Ann Emerg Med. 1996;27:427–432
  15. Spagrud LJ, Piira T, von Baeyer CL. Children's self-report of pain intensity. Am J Nurs. 2003;103:62–64
  16. Holdgate A, Asha S, Craig J, et al. Comparison of a verbal numeric rating scale with the VAS for the measurement of acute pain. Emerg Med (Fremantle). 2003;15:441–446
  17. Paech MJ, Lim CB, Banks SL, et al. A new formulation of nasal fentanyl spray for postoperative analgesia: a pilot study. Anaesthesia. 2003;58:740–744
  18. Wong P, Chadwick FD, Karovits J. Intranasal fentanyl for postoperative analgesia after elective caesarean section. Anaesthesia. 2003;58:818–819
  19. Galinkin JL, Fazi LM, Cuy RM, et al. Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology. 2000;93:1378–1383
  20. O'Neil G, Paech M, Wood F. Preliminary clinical use of a patient controlled intranasal analgesia (PCINA) device. Anaesth Intensive Care. 1997;25:408–412
  21. Finn J, Wright J, Fong J, et al. A randomised crossover trial of patient controlled intranasal fentanyl and oral morphine for procedural wound care in adult patients with burns. Burns. 2004;30:262–268
  22. Borland ML, Bergesio R, Pascoe EM, et al. Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: a randomised double blind crossover study. Burns. 2005;31:831–837

 Supervising editor: Steven M. Green, MD

 Author contributions: MB conceived, designed, and conducted the study and undertook article writing and acts as guarantor. IJ assisted in planning and manuscript revision and undertook statistical analysis. BK conducted patient enrollments and article revision. DO'B was involved in planning, obtaining funding, and article revision.

 Reprints not available from the authors.

 Funding and support: Funded by an ACEM Morson Taylor Research Grant.

PII: S0196-0644(06)00873-0

doi: 10.1016/j.annemergmed.2006.06.016

Annals of Emergency Medicine
Volume 49, Issue 3 , Pages 335-340 , March 2007

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