Intranasal analgesia for prehospital management of children in pain

Background: Prehospital management of pain in children could be considered substandard, with not all children in pain receiving adequate and timely analgesia. With intravenous access being difficult to obtain and many children displaying a fear of needles, the common barrier highlighted is the route of easily administered analgesia. Aims: To explore the use of intranasal analgesia for the management of children in pain in the prehospital environment. Methods: A search was completed using One Search and EBSCOhost research interface of the CINAHL Plus database. This scoping review identified literature on the chosen topic of interest, which was then refined to six studies exploring three key themes: efficacy, safety and feasibility. Results: 621 children were included across the six studies, receiving either morphine, diamorphine, ketamine or fentanyl. Similar efficacy was seen between morphine and fentanyl, as well as fentanyl and ketamine. Adverse events were more prevalent in the ketamine groups; however, these were considered minor, and no serious adverse events were recorded. Sedation levels were not thought to be significant and could be considered advantageous in this patient group. Conclusion: Intranasal drug administration provides an efficacious route that is non-invasive and safe to administer in challenging environments. A sub-dissociative dose of ketamine is as efficacious as fentanyl, while offering a non-opioid alternative.