Abstract

Introduction
Pre-hospital analgesic treatment of injured children is suboptimal with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain.
Methods
We performed a rapid evidence review, searching from inception to 17th December, 2018 CINAHL, MEDLINE and Google Scholar. We included studies of children <18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis.
Results
From 310 articles screened, 23 received a full text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of IN fentanyl (n=8) with one reporting IN ketamine and the other IN s-ketamine. Narrative synthesis showed that IN fentanyl appeared effective at reducing pain and safe, however its ability to increase analgesia administration rates were unclear. The effectiveness, safety and ability of IN ketamine and s-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting.
Conclusion
Interventional studies are needed to determine with a higher confidence the effectiveness and safety of intranasal analgesics (fentanyl, ketamine, s-ketamine, diamorphine) for children in the pre-hospital setting.