INTRANASAL DIAMORPHINE FOR PEDIATRIC ANALGESIA - ASSESSMENT OF SAFETYAND EFFICACY

Objective - To evaluate the safety and efficacy of intranasal diamorph ine as an analgesic for use in children in accident and emergency (A&E ). Methods - A prospective, randomised clinical trial with consecutive recruitment of patients aged between 3 and 16 years with clinically s uspected limb fractures. One group received 0.1 mg/kg intranasal diamo rphine, and the other group received 0.2 mg/kg intramuscular morphine. At 0, 5, 10, 20, and 30 minutes pain scores, Glasgow coma score, and peripheral oxygen saturations were recorded; parental acceptability wa s assessed at 30 minutes. Results - 58 children were recruited, with c omplete data collection in 51 (88%); the median summed decrease in pai n score was better for intranasal diamorphine than intramuscular morph ine (9 v 8), though this was not significant (P = 0.4, Mann-Whitney U test). The episode was recorded as ('acceptable'' in all parents whose child received intranasal diamorphine, compared with only 55% of pare nts in the intramuscular morphine group (P < 0.0001, Fisher's exact te st). There was no incidence of decreased peripheral oxygen saturation or depression in the level of consciousness in any patient. Conclusion s - Intranasal diamorphine is an effective, safe, and acceptable metho d of analgesia for children requiring opiates in the A&E department.