Intranasal fentanyl and intravenous morphine did not differ for pain relief in children with closed long-bone fractures

摘要

QUESTIONIn children presenting to the emergency department (ED) with acute long-bone fractures, is intranasal fentanyl equivalent to intravenous (IV) morphine for pain control?METHODSDesign: randomised controlled trial. Allocation: {concealed}.Blinding: blinded (patients, {clinicians, data collectors, outcome assessors, data analysts, and monitoring committee}).Follow-up period: 30 minutes after initial analgesic administration.Setting: tertiary paediatric ED in a hospital in Australia. Patients: 67 patients 7-15 years of age (mean age 11 y, 79% with fractures of the radius or ulna), who presented to the ED with clinically deformed, closed, long-bone fractures. Exclusion criteria were narcotic analgesia within 4 hours of arrival, significant head injury, allergy to opiates, nasal blockage or trauma, and inability to perform pain scoring. Intervention: 33 patients were given intranasal fentanyl (weight-determined initial dose: 21-30 kg, 30mug; 31-40 kg, 45 mug; 41-50 kg, 60 mug) plus IV normal saline (placebo). 34 patients were given IV morphine (initial dose: 21-30 kg, 2 mg; 31-40 kg, 3 mg; 41-50 kg, 4 mg) plus intranasal placebo. Additional fentanyl (15 mug) or morphine (1 mg) could be given every 5 minutes until pain relief, patient refusal, or maximum number of doses ( = initial dose). Outcomes: patient-reported pain (100 mm unmarked visual analogue scale [VAS], 0 = no pain and 100 = worst pain) assessed at baseline and 5, 10, 20, and 30 minutes after analgesic administration; and adverse effects, including sedation and respiratory or cardiovascular effects. 32 patients per group were required to detect a 13 mm change in pain score (baseline 80 mm, power 90%, alpha = 0.05).