Intranasal Ketamine, Fentanyl Equally Effective Against Pain in Kids

By Rob Goodier

NEW YORK (Reuters Health) - A new trial of intranasal ketamine versus fentanyl found that the two provide similar pain relief in children suffering from moderate to severe pain from limb injuries.

There could be at least one difference, however: Ketamine appeared to cause more minor adverse events, though the difference was not statistically significant, researchers report online November 17 in Annals of Emergency Medicine.

"Fentanyl is well established as a safe and effective intranasal analgesic for children requiring opioid analgesia in the ED and avoids the need for IV access or intramuscular injections," said lead author Dr. Andis Graudins, an emergency medicine specialist at Monash University in Clayton, Victoria, in Australia.

"Sub-dissociative dose ketamine was equally effective in our study and could be considered as an alternative intranasal analgesic in cases where an opioid may be contraindicated or where initial intranasal opioid analgesia has been inadequate or resulted in a poor response," Dr. Graudins told Reuters Health by email.

The researchers conducted a randomized, doubled-blinded trial comparing intranasal fentanyl at 1.5 mg/kg to ketamine at 1mg/kg. They collected data from 73 children with a median age of eight years and a baseline pain score of 80 mm on a 100 mm visual analog scale.

Thirty minutes after administration, the median pain reduction was 40 mm with fentanyl and 45 mm with ketamine, a non-significant difference. The effect remained at the 60-minute follow-up.

Seventy-eight percent of the children on ketamine reported adverse side effects, mostly mild, compared to 40% of the fentanyl group (difference, 38%; 95% CI, -58% to 16%). Those included bad taste, drowsiness, dizziness, itchy nose, nausea, dysphoria, hallucinations and other symptoms.

"Adverse events with ketamine were more frequent, however they were all mild and expected. Importantly, no child suffered excess sedation or any significant hallucinations or emergency phenomena with ketamine that can be seen sometimes after its use for procedural sedation at higher doses," Dr. Graudins said.

SOURCE: https://bit.ly/1ubKHjk

Ann Emerg Med 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - https://about.reuters.com/fulllegal.asp