Discover the innovative use of intranasal fentanyl for managing severe pain in children. Learn about its fast-acting effects and lower adverse effects compared to traditional pain medications. The discussion highlights effective dosing techniques and emphasizes that intranasal options may simplify administration in emergency settings. Additionally, explore other important pain management strategies, including non-pharmacologic methods and alternative medications.
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volunteer_activism ADVICE
Intranasal Fentanyl Dosage Advice
Use intranasal fentanyl as first-line pain management in children with severe acute pain.
Administer 1.5 to 2 micrograms per kilogram using IV formulation with an atomizer intranasally.
insights INSIGHT
Early Effectiveness of Intranasal Fentanyl
Intranasal fentanyl controls pain more effectively in the first 15-20 minutes than other options.
It also causes fewer side effects like nausea and vomiting.
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There are many non-pharmacologic options for pain (i.e. ice, elevation) as well as more conventional medication options (i.e. acetaminophen, NSAIDS) but in severe pain stronger medications might be indicated.
These stronger medications include options such as IV morphine, a subdissociative dose of ketamine, as well as intranasal fentanyl.
Intranasal fentanyl has many advantages:
Studies have shown it might be more effective early on in controlling pain, as in the first 15-20 minutes after administration, and then becomes equivalent to other pain control options
Total adverse effects were also lower with IN fentanyl, including low rates of nausea and vomiting
To administer, use the IV formulation with an atomizer and spray into the nose; therefore, you do not need an IV line
Dose is 1-2 micrograms per kilogram, can be redosed once at 10 minutes.
Don’t forget about gabapentinoids for neuropathic pain, muscle relaxants for muscle spasms, and nerve blocks when appropriate. (Disclaimer: muscle relaxers have not been well studied in children)
References
Alsabri M, Hafez AH, Singer E, Elhady MM, Waqar M, Gill P. Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2024 Oct 1;40(10):748-752. doi: 10.1097/PEC.0000000000003187. Epub 2024 Apr 11. PMID: 38713846.
Bailey B, Trottier ED. Managing Pediatric Pain in the Emergency Department. Paediatr Drugs. 2016 Aug;18(4):287-301. doi: 10.1007/s40272-016-0181-5. PMID: 27260499.
Hadland SE, Agarwal R, Raman SR, Smith MJ, Bryl A, Michel J, Kelley-Quon LI, Raval MV, Renny MH, Larson-Steckler B, Wexelblatt S, Wilder RT, Flinn SK. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics. 2024 Sep 30:e2024068752. doi: 10.1542/peds.2024-068752. Epub ahead of print. PMID: 39344439.
Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4
Emergency Medical Minute