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Intranasal diamorphine for paediatric analgesia: assessment of safety and efficacy
J A Wilson1, J M Kendall, P Cornelius
1Department of Anaesthetics, Hammersmith Hospital, London, United Kingdom.
Insights
Intranasal diamorphine provides effective pain relief for children in the accident and emergency department. This method was found to be safe and highly acceptable to parents compared to traditional intramuscular morphine.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Pharmacology
Background:
- Accurate pain assessment and effective analgesia are crucial for pediatric patients in emergency settings.
- Traditional methods of pain management in children may have limitations in terms of efficacy and patient/parental acceptance.
Purpose of the Study:
- To assess the safety and efficacy of intranasal diamorphine as a pain relief option for pediatric patients in the accident and emergency (A&E) department.
- To compare intranasal diamorphine with intramuscular morphine in terms of pain reduction and parental acceptability.
Main Methods:
- A prospective, randomized clinical trial involving children aged 3-16 years with suspected limb fractures.
- Patients received either intranasal diamorphine (0.1 mg/kg) or intramuscular morphine (0.2 mg/kg).
- Pain scores, Glasgow Coma Scale, and oxygen saturation were monitored; parental acceptability was assessed.
Main Results:
- While not statistically significant, intranasal diamorphine showed a trend towards better pain reduction compared to intramuscular morphine.
- Parental acceptability was significantly higher for intranasal diamorphine (100%) versus intramuscular morphine (55%).
- No adverse events were observed regarding oxygen saturation or consciousness levels in either group.
Conclusions:
- Intranasal diamorphine is a safe and effective analgesic for children in the accident and emergency department.
- Its high parental acceptability makes it a favorable option for pediatric pain management in this setting.
Objective:
To evaluate the safety and efficacy of intranasal diamorphine as an analgesic for use in children in accident and emergency (A&E).
Methods:
A prospective, randomised clinical trial with consecutive recruitment of patients aged between 3 and 16 years with clinically suspected limb fractures. One group received 0.1 mg/kg intranasal diamorphine, and the other group received 0.2 mg/kg intramuscular morphine. At 0, 5, 10, 20, and 30 minutes pain scores, Glasgow coma score, and peripheral oxygen saturations were recorded; parental acceptability was assessed at 30 minutes.
Results:
58 children were recruited, with complete data collection in 51 (88%); the median summed decrease in pain score was better for intranasal diamorphine than intramuscular morphine (9 v 8), though this was not significant (P = 0.4, Mann-Whitney U test). The episode was recorded as "acceptable" in all parents whose child received intranasal diamorphine, compared with only 55% of parents in the intramuscular morphine group (P < 0.0001, Fisher's exact test). There was no incidence of decreased peripheral oxygen saturation or depression in the level of consciousness in any patient.
Conclusions:
Intranasal diamorphine is an effective, safe, and acceptable method of analgesia for children requiring opiates in the A & E department.