Effectiveness of Prehospital Morphine, Fentanyl, and Methoxyflurane in Pediatric Patients

Abstract

Intranasal fentanyl and intravenous morphine are equally effective analgesic agents in pediatric patients with moderate to severe acute pain in the out-of-hospital setting. Methoxyflurane is less effective in comparison with both morphine and fentanyl, but is an effective analgesic in the majority of children.

Prehospital pain management of injured children: a systematic review of current evidence

“…Methoxyflurane was inferior in providing effective analgesia. Effective analgesia was defined as a reduction in pain score of 30% or greater [13]. However, another study found that methoxyflurane had a significant effect on pain reduction as assessed by provider and parents [14].…”

“…Two LOE-2 studies examined efficacy of analgesia. Opioids were included in both studies (Table 2) [13,15].…”

“…Five studies evaluated analgesic efficacy [11][12][13][14][15]. Efficacy was defined as a measurable reduction in pain upon the administration of analgesics.…”

An Assessment of Newly Identified Barriers to and Enablers for Prehospital Pediatric Pain Management

“…Intranasal fentanyl has been shown to be effective in treating pediatric pain in the emergency department and prehospital settings. 24,25 Because this is a newer analgesic and route of analgesic administration in the prehospital setting, it is possible that with time and further training, paramedics will become more comfortable with its use in pediatric pain management. However, in the system studied, the paramedic option of intranasal fentanyl had been available for more than 2 years before this study was completed, suggesting that other factors discouraging its use may be at work.…”

An open-label randomised controlled trial on the efficacy of adding intranasal fentanyl to intravenous tramadol in patients with moderate to severe pain following acute musculoskeletal injuries

“…(13) Studies conducted in prehospital settings have shown that intranasal fentanyl is as effective an analgesic as intravenous morphine in adult (14) and paediatric patients. (15) Although the evidence regarding the use of intranasal fentanyl in EDs is limited, the few published studies show promising results. In one study, intranasal fentanyl was shown to be as effective an analgesic as intramuscular morphine in children presenting to the ED.…”