New intranasal pain relief for kids

An anesthetic, given by nasal spray, is a safe, needle-free alternative to opiates for relieving moderate to severe pain in children with limb injuries, according to the first randomized, controlled trial to compare intranasal analgesics in children in the emergency department.

The Pain in Children Fentanyl OR Ketamine (PICHFORK) Trial randomized 80 children aged 3 to 13 years (median, 8 years) and weighing less than 50 kg to receive either 1.5 μg/kg of the opiate fentanyl or 1 mg/kg of the anesthetic ketamine intranasally. All the children had isolated limb injuries and pain scores higher than 6 on a scale of 10 (median score, 8). In addition to the intranasal drug, they were given oral ibuprofen, 10 mg/kg.

Among the 73 children available for analysis (37 fentanyl, 36 ketamine), median pain reduction after 30 minutes was 4.45 for ketamine and 4 for fentanyl. The reductions for both drugs persisted at 60 minutes. Eighty-three percent of patients reported satisfaction with ketamine compared with 72% for fentanyl. Minor adverse events such as drowsiness or dizziness were reported more often for ketamine than fentanyl-by 78% and 40% of patients, respectively.

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The study indicates that intranasal ketamine is a safe alternative for children who can’t tolerate opiates and offers another option for delivering analgesia without using needles.

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