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The Safety of High-Dose Intranasal Fentanyl in the Pediatric Emergency Department

Tucker Anderson, Camden Harrell, Mark Snider

    Pediatric Emergency Care
    |February 1, 2022
    PubMed

    Insights

    High-dose intranasal (IN) fentanyl, over 100 μg, is safe for pediatric patients in emergency settings. This study found no significant adverse events, supporting its use for acute pain management.

    Area of Science:

    • Pediatric Emergency Medicine
    • Pharmacology
    • Pain Management

    Background:

    • Intranasal (IN) fentanyl is used for pain management in pediatric emergency departments.
    • Higher doses of IN fentanyl (greater than 100 μg) have not been extensively studied in pediatric populations.

    Purpose of the Study:

    • To determine the safety of administering IN fentanyl at doses exceeding 100 μg in pediatric patients.
    • To assess adverse events associated with higher-dose IN fentanyl in a pediatric emergency setting.

    Main Methods:

    • Retrospective chart review of pediatric patients who received IN fentanyl.
    • Data collected from an urban, tertiary care emergency department between 2011 and 2017.
    • Analysis of adverse events documented through the hospital's voluntary safety reporting system.

    Main Results:

    • 3205 pediatric patients received over 100 μg of IN fentanyl.
    • Only 3 adverse events were documented among patients receiving doses greater than 100 μg.
    • No patients required naloxone or invasive respiratory support.

    Conclusions:

    • Doses of IN fentanyl greater than 100 μg are safe for pediatric patients.
    • No clinically significant adverse outcomes were observed in this 7-year study.
    • Findings support increased utilization of higher-dose IN fentanyl for acute pain in emergency and prehospital settings.
    Abstract

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