Table 1.
Characteristics of randomized trials comparing intranasal ketamine and intranasal fentanyl for acute pain management in ED pediatric patients.
| Study | Pain Causes | Population | Intervention [Number of Patients] | Comparison [Number of Patients] |
|---|---|---|---|---|
| Graudins 2015, Australia | Acute Isolated Extremity Injury | Children aged 3-13 years and weight < 50kg with an acute isolated extremity injury and moderate to severe pain at triage. | Intranasal Ketamine (1 mg/kg) [N = 36]1 33/36 (92%) received concomitant ibuprofen |
Intranasal Fentanyl (1.5μg/kg) [N = 37]1 33/37 (89%) received concomitant ibuprofen |
| Reynolds 2017, United States | Acute Isolated Extremity Injury | Children aged 4-17 years and weight < 70kg with suspected acute isolated extremity injury and moderate to severe pain at triage. | Intranasal Ketamine (1 mg/kg) 2nd dose at least 20 minutes after the first dose at the discretion of physician. [N = 46]2 34/43 (79%) received concomitant ibuprofen, 7 (16%) received concomitant acetaminophen and 1 (2%) received both. |
Intranasal Fentanyl (1.5μg/kg) 2nd dose at least 20 minutes after the first dose at the discretion of physician. [N = 45]2 35/44 (80%) received ibuprofen, 5 (11%) received acetaminophen and 3 (7%) received both. |
| Frey 2018, United States | Acute Extremity Injury | Children aged 8-17 years with an acute extremity injury and moderate to severe pain at triage. | Intranasal Ketamine (1.5 mg/kg) [N = 45]3 4/44 (9%) received ibuprofen and 1/44 (2%) received acetaminophen prior to ED arrival. |
Intranasal Fentanyl (2 μg/kg) [N = 45]3 4/42 (10%) received ibuprofen and 2 (5%) received acetaminophen prior to ED arrival. |
| Quinn 2018, United States | Acute Pain Either Musculoskeletal or Abdominal | Children aged 3-17 years and weight < 64kg with acute moderate to severe pain at triage. | Intranasal Ketamine (1 mg/kg) [N = 11] 2/11 (18%) received ibuprofen and 2/11 (18%) received acetaminophen prior to intervention. |
Intranasal Fentanyl (1.5μg/kg) [N = 11] 2/11 (18%) received ibuprofen and 2/11 (18%) received acetaminophen prior to intervention. |
Number of patients who were randomized. Five patients in the ketamine group did not complete the 60-minute follow-up mainly because rescue analgesia was needed, and 6 patients in the fentanyl group did not complete the 60-minute follow-up mainly because rescue analgesia was needed. To note, this was predicted in their protocol as further participation in the study was terminated at rescue medication administration.
Number of patients who were randomized. Three patients randomized to ketamine withdrew prior to intervention while 1 patient randomized to fentanyl was lately recognized as a screen failure.
One patient who was randomized to ketamine did not receive the intervention and 3 patients who were initially allocated to fentanyl did not receive it. The reasons included inability to provide urine for pregnancy test, parental preference, clinical preference and unavailability of medication.