Many children who present to the ED do so with a primary complaint of pain. While much adult medical literature is devoted to the management of pain, there is a significant lack of knowledge for children.
“Fentanyl (a synthetic opioid 80-100 times more potent than morphine) is an ideal intranasal agent for pain management (simple to administer and cost effective) with a rapid onset of action and bio-availability of 70-80%. IN use in children however is limited by pediatrician anxiety over side-effects (including respiratory depression)”.
A retrospective chart review from a large (approximately 100,000 visits per year), single, urban, tertiary care ED investigated 3,205 children aged 5-18 years for adverse incidents following the use of IN fentanyl (2-5 micrograms/kg to a maximum of 200 micrograms) at doses >100 micrograms (range 102-256 micrograms).
0.4% of children given IN fentanyl for pain have adverse events, most related to physician dose/route error (0.09% associated with a dose grater than 100 micrograms). No child (in this study) required naloxone (reversal agent) or invasive respiratory support.
IN fentanyl appears to be a safe and effective treatment to manage pain in older children.
