Traditionally, the intranasal analgesic drug of choice in children has been diamorphine. Prompted by the Department of Health bulletin in December 2004,1 warning of an impending shortage of diamorphine, we sought a viable alternative intranasal drug for providing analgesia for children with acute pain.
Alfentanil has a favourable pharmacokinetic profile for nasal administration with maximal plasma concentrations at 9 minutes and calculated bioavailability of 64.96%.2 It has been suggested from separate studies that intranasal alfentanil is safe and effective for premedication in children3 and comparable to intravenous for postoperative pain relief.4 Its relatively short duration of action also means that lengthy (longer than 2 h) observation after using the drug is unnecessary.
We report our experience in using intranasal alfentanil as the initial analgesic administered to children presenting to the emergency department in acute moderate to severe pain. A dose of 0.01 mg/kg alfentanil in 0.2 ml of solution was administered through atomiser to children without contraindications to either route or drug. Thirty six patients received the drug over a 2 month period, with a median age of 8 years (range 1.5–16 years), and 1.8:1 male:female ratio. Median dose administered was 0.275 mg (range 0.1–0.7 mg). Ninety four per cent of children received the drug for orthopaedic injuries (n = 33). No adverse events were recorded. Thirty per cent of patients (10/33) required further analgesia or regional anaesthesia to facilitate further emergency department management, and all of these were admitted to hospital. Fifty six per cent (20/36) of all patients required admission but none was because of drug effects. Nursing and parental acceptability was high for both ease of administration and analgesic effect.
Intranasal alfentanil has proven to be safe and effective in providing adequate pain relief in our experience in a selected paediatric population. Further evaluation is warranted, and ongoing.
Footnotes
Competing interests: none declared
References
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