Intranasal Procedural Sedation and Analgesia in Children
Intranasal fentanyl has been used for the management of acute or procedural pain in children for more than a decade. In 2011, Mudd reviewed 12 pediatric observational, placebo-controlled and comparison studies. The author found consistently lower pain scores with intranasal fentanyl when compared to placebo and similar scores when it has been compared to IM or IV morphine. Intranasal fentanyl has been shown to be effective in a variety of settings, including emergency departments (ED), procedural areas, and operating rooms.
In a 2012 study comparing the postoperative analgesia provided by intra-operative administration of intranasal fentanyl (2 mcg/kg) and IV or IM morphine (0.1 mg/kg) during bilateral myringotomy and ventilating tube placement, Hippard and colleagues found that the three options provided equivalent postoperative pain control. The groups had similar rates of complications, time to discharge, and parental satisfaction scores.
Intranasal fentanyl has been found to be effective over a range of ages, from infants as young as 6 months to adolescents. Cole and colleagues evaluated pain scores in 46 children between 1 and 3 years of age given intranasal fentanyl for acute pain in the ED. A dose of 1.5 mcg/kg was administered with an atomizer and pain was assessed with the Faces, Legs, Arms, Cry, Consolability (FLACC) scale. The mean FLACC score of 8 at baseline declined to a mean of 2 at 10 minutes (p < 0.0001). Pain scores were significantly lower than baseline in 93% of patients at 10 minutes and in 98% at 30 minutes. No serious adverse effects were noted. Mean heart rate and respiratory rate declined after fentanyl administration, but no measurements were below age-related normal values.
Sufentanil has also been used for intranasal sedation and analgesia. It is approximately 5–10 times more potent and twice as lipophilic as fentanyl. Although not as widely studied, sufentanil appears to be an effective alternative to fentanyl and may be better tolerated. Roelofse and colleagues compared combinations of intranasal sufentanil/midazolam and ketamine/midazolam for pre-induction sedation in 50 children between 5–7 years of age. There were no significant differences between the groups in sedation or anxiety, heart rate, blood pressure, or oxygen saturation. The authors reported no cases of respiratory depression.
Fentanyl and Sufentanil
Intranasal fentanyl has been used for the management of acute or procedural pain in children for more than a decade. In 2011, Mudd reviewed 12 pediatric observational, placebo-controlled and comparison studies. The author found consistently lower pain scores with intranasal fentanyl when compared to placebo and similar scores when it has been compared to IM or IV morphine. Intranasal fentanyl has been shown to be effective in a variety of settings, including emergency departments (ED), procedural areas, and operating rooms.
In a 2012 study comparing the postoperative analgesia provided by intra-operative administration of intranasal fentanyl (2 mcg/kg) and IV or IM morphine (0.1 mg/kg) during bilateral myringotomy and ventilating tube placement, Hippard and colleagues found that the three options provided equivalent postoperative pain control. The groups had similar rates of complications, time to discharge, and parental satisfaction scores.
Intranasal fentanyl has been found to be effective over a range of ages, from infants as young as 6 months to adolescents. Cole and colleagues evaluated pain scores in 46 children between 1 and 3 years of age given intranasal fentanyl for acute pain in the ED. A dose of 1.5 mcg/kg was administered with an atomizer and pain was assessed with the Faces, Legs, Arms, Cry, Consolability (FLACC) scale. The mean FLACC score of 8 at baseline declined to a mean of 2 at 10 minutes (p < 0.0001). Pain scores were significantly lower than baseline in 93% of patients at 10 minutes and in 98% at 30 minutes. No serious adverse effects were noted. Mean heart rate and respiratory rate declined after fentanyl administration, but no measurements were below age-related normal values.
Sufentanil has also been used for intranasal sedation and analgesia. It is approximately 5–10 times more potent and twice as lipophilic as fentanyl. Although not as widely studied, sufentanil appears to be an effective alternative to fentanyl and may be better tolerated. Roelofse and colleagues compared combinations of intranasal sufentanil/midazolam and ketamine/midazolam for pre-induction sedation in 50 children between 5–7 years of age. There were no significant differences between the groups in sedation or anxiety, heart rate, blood pressure, or oxygen saturation. The authors reported no cases of respiratory depression.
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