Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso‐occlusive pain: A multicenter pediatric emergency medicine perspective

Abstract

Children with sickle cell disease (SCD) commonly experience vaso‐occlusive pain episodes (VOE) due to sickling of erythrocytes, which often requires care in the emergency department. Our objective was to assess the use and impact of intranasal fentanyl for the treatment of children with SCD‐VOE on discharge from the emergency department in a multicenter study. We conducted a cross‐sectional study at 20 academic pediatric emergency departments in the United States and Canada. We used logistic regression to test bivariable and multivariable associations between the outcome of discharge from the emergency department and candidate variables theoretically associated with discharge. The study included 400 patients; 215 (54%) were female. The median age was 14.6 (interquartile range 9.8, 17.6) years. Nineteen percent (n = 75) received intranasal fentanyl in the emergency department. Children who received intranasal fentanyl had nearly nine‐fold greater adjusted odds of discharge from the emergency department compared to those who did not (adjusted odds ratio 8.99, 95% CI 2.81–30.56, p < .001). The rapid onset of action and ease of delivery without intravenous access offered by intranasal fentanyl make it a feasible initial parenteral analgesic in the treatment of children with SCD presenting with VOE in the acute‐care setting. Further study is needed to determine potential causality of the association between intranasal fentanyl and discharge from the emergency department observed in this multicenter study.

New Horizons in Emergency Department Management of Pediatric Sickle Cell Disease

“…Intranasal fentanyl should be used as a bridge to administration of intravenous opioids due to its ease and rapidity of administration and has been associated with increased likelihood of discharge in children and young adults with SCD. 14 Patients should be reassessed every 30-60 minutes for pain relief and side effects. If pain persists, an opioid should be readministered every 30-60 minutes until pain is under control.…”

Intranasal Therapy in Palliative Care

“…Regarding sedative, antidepressant or antianxiety drugs, ketamine and dexmedetomidine are the most studied (Table 2). There is evidence in the medical literature of the high effectiveness, efficiency, and ease of intranasal use of these drugs [32,43,46]. Interesting findings are presented in the review by Lemus et al (2022) where, based on a series of case reports, dexmedetomidine was shown to be highly effective in palliative and hospice care [59].…”

Journal update monthly top five

“…Vaso-occlusive episodes (VOEs) in patients with sickle cell disease (SCD) often require strong opiate analgesia and may necessitate hospital admission. This observational study determined the association of intranasal fentanyl with rates of hospital admission in children and young people presenting to ED with VOE 3…”