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

Borland, Meredith L; Jacobs, Ian; King, Barbara; O’Brien, Debra

doi:10.1016/j.annemergmed.2006.06.016

Cited by 246 publications

(126 citation statements)

References 20 publications

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“…Furthermore, the children in this study received a mean IN fentanyl dose of 1.7 μg/kg and no serious adverse events were reported. 37 In an emergency department study using higher doses, Furyk et al randomized children with clinically suspected extremity fractures to receive fentanyl 4 μg/kg IN or morphine at 0.2 mg/kg IV. Both groups experienced a significant reduction in pain, and the difference in effect of IN fentanyl versus IV morphine did not reach statistical significance but favored IN fentanyl.…”

Section: Safety and Efficacymentioning

confidence: 99%

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Gausche‐Hill¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

120

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Background. The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. Objective. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Results. Four strong

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Section: Safety and Efficacymentioning

confidence: 99%

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Gausche‐Hill¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

120

View full text Add to dashboard Cite

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“…Oral transmucosal fentanyl citrate should be carefully used in children less than 6 years of age [94][95][96][97]. Intranasal fentanyl (dosed 1-2 lg/kg) has been effectively used in premedication, emergency analgesia, and palliative care [98][99][100][101][102].…”

Section: Transmucosal Fentanylmentioning

confidence: 99%

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

et al. 2017

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Fentanyl and its derivatives sufentanil, alfentanil, and remifentanil are potent opioids. A comprehensive review of the use of fentanyl and its derivatives in the pediatric population was performed using the National Library of Medicine PubMed. Studies were included if they contained original pharmacokinetic parameters or models using established routes of administration in patients younger than 18 years of age. Of 372 retrieved articles, 44 eligible pharmacokinetic studies contained data of 821 patients younger than 18 years of age, including more than 46 preterm infants, 64 full-term neonates, 115 infants/toddlers, 188 children, and 28 adolescents. Underlying diagnoses included congenital heart and pulmonary disease and abdominal disorders. Routes of drug administration were intravenous, epidural, oral-transmucosal, intranasal, and transdermal. Despite extensive use in daily clinical practice, few studies have been performed. Preterm and term infants have lower clearance and protein binding. Pharmacokinetics was not altered by chronic renal or hepatic disease. Analyses of the pooled individual patients' data revealed that clearance maturation relating to body weight could be best described by the Hill function for sufentanil (R 2 = 0.71, B max 876 mL/min, K 50 16.3 kg) and alfentanil (R 2 = 0.70, B max (fixed) 420 mL/min, K 50 28 kg). The allometric exponent for estimation of clearance of sufentanil was 0.99 and 0.75 for alfentanil clearance. Maturation of remifentanil clearance was described by linear regression to bodyweight (R 2 = 0.69). The allometric exponent for estimation of remifentanil clearance was 0.76. For fentanyl, linear regression showed only a weak correlation between clearance and bodyweight in preterm and term neonates (R 2 = 0.22) owing to a lack of data in older age groups. A large heterogeneity regarding study design, clinical setting, drug administration, laboratory assays, and pharmacokinetic estimation was observed between studies introducing bias into the analyses performed in this review. A limitation of this review is that pharmacokinetic data, based on different modes of administration, dosing schemes, and parameter estimation methods, were combined.The online version of the original article can be found under

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“…As is evident in this study, pain rating scales were adequately tailored to pre-specified age groups, with younger children using the Face Pain Scale-Revised (FPS-R) and older children using the Visual Analog Scale (VAS), taking into consideration each age group's cognitive abilities, which confirms the appropriate utilization and strength of the methodology. The authors in this trial used an adequate dose of intranasal fentanyl of 1.5 µg/kg, as the average of 1-2 µg/kg, although some other trials had a higher dosing regimen (10,11). This dosage was comparable to that in the majority of studies conducted on intranasal fentanyl administered via atomization (4,(12)(13)(14)(15).…”

Section: Resultsmentioning

confidence: 74%

“…In our opinion, the results obtained from this study highlighted the higher profile of adverse events associated with ketamine than that with intranasal ketamine in comparison with intranasal fentanyl. Intranasal fentanyl has weidely been widely been used over the past years, and for quite some time now, and it has been proven by several studies to be a safe and effective me of analgesia with limited side effects (10,11,18).…”

Section: Resultsmentioning

confidence: 99%