Intranasal diamorphine integrated care pathway for paediatric analgesia in the accident and emergency department

Gahir, K K; Ransom, P A

doi:10.1136/emj.2006.034637

Cited by 5 publications

(1 citation statement)

References 2 publications

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“…The intranasal (IN) route has been investigated as an alternative [ 9 , 10 ], Lazanda® fentanyl nasal spray was approved by the FDA in July 2011 for the management of breakthrough pain in adult patients with cancer [ 11 ]. IN fentanyl administration might be preferred because IN delivery does not require establishment of IV access; thus, there are no inherent delays with drug-delivery preparation and administration, which would reduce time to analgesic relief compared with IV opioids [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Intranasal fentanyl spray versus intravenous opioids for the treatment of severe pain in patients with cancer in the emergency department setting: A randomized controlled trial

et al. 2020

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Intranasal fentanyl (INF) quickly and noninvasively relieves severe pain, whereas intravenous hydromorphone (IVH) reliably treats severe cancer pain but requires vascular access. The trial evaluated the efficacy of INF relative to IVH for treating cancer patients with severe pain in an emergency department (ED) setting. Methods We randomized 82 patients from a comprehensive cancer center ED to receive INF (n = 42) or IVH (n = 40). Eligible patients reported severe pain at randomization (�7, scale: 0 "none" to 10 "worst pain"). We conducted non-inferiority comparisons (non-inferiority margin = 0.9) of pain change from treatment initiation (T0) to one hour later (T60). T0 pain ratings were unavailable; therefore, we estimated T0 pain by comparing 1) T60 ratings, assuming similar group T0 ratings; 2) pain change, estimating T0 pain = randomization ratings, and 3) pain change, with T0 pain = 10 (IVH group) or T0 pain = randomization rating (INF group). Results At T60, the upper 90% confidence limit (CL) of the mean log-transformed pain ratings for the INF group exceeded the mean IVH group rating by 0.16 points (>pain). Substituting randomization ratings for T0 pain, the lower 90% CL of mean pain change in the INF group extended 0.32 points below (

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Section: Introductionmentioning

confidence: 99%

Intranasal fentanyl spray versus intravenous opioids for the treatment of severe pain in patients with cancer in the emergency department setting: A randomized controlled trial

et al. 2020

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Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department

et al. 2012

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A survey of intranasal medication use in the paediatric emergency setting in England and Wales

Hadley

Maconochie

Jackson

2010

Emergency Medicine Journal

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For analgesia and sedation in the paediatric setting, intranasal medication is favourable for several reasons, in particular ease of administration and rapid onset of action. A survey was conducted of all Emergency Departments in England and Wales regarding their use of intranasal medication in children. Approximately 50% use intranasal medication, commonly intranasal diamorphine with sporadic use of other opiates. Intranasal midazolam is used for sedation but is less well tolerated than when administered orally. Intranasal diamorphine, however, is safe and effective in the management of pain in the paediatric emergency setting and its ease of administration makes it ideal for use in the already traumatised child.

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Intranasal diamorphine integrated care pathway for paediatric analgesia in the accident and emergency department

Cited by 5 publications

References 2 publications

Intranasal fentanyl spray versus intravenous opioids for the treatment of severe pain in patients with cancer in the emergency department setting: A randomized controlled trial

Intranasal fentanyl spray versus intravenous opioids for the treatment of severe pain in patients with cancer in the emergency department setting: A randomized controlled trial

Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department

A survey of intranasal medication use in the paediatric emergency setting in England and Wales

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