Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies: A Systematic Review and Meta-analysis

Mohammed Alsabri; Abdelrahman H Hafez; Emad Singer; Mahmoud M Elhady; Muhammad Waqar; Paviter Gill

doi:10.1097/PEC.0000000000003187

Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies: A Systematic Review and Meta-analysis

Pediatr Emerg Care. 2024 Apr 12. doi: 10.1097/PEC.0000000000003187. Online ahead of print.

Authors

Mohammed Alsabri¹, Abdelrahman H Hafez², Emad Singer³, Mahmoud M Elhady⁴, Muhammad Waqar⁵, Paviter Gill⁶

Affiliations

¹ From the Pediatric Emergency Department, Woodhull Hospital, New York, NY.
² Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
³ The University of Texas MD Anderson Cancer Center, Houston, TX.
⁴ Faculty of Medicine, Benha University, Qalubiya, Egypt.
⁵ Augusta University Medical Center, Augusta, GA.
⁶ Harbin Medical University, Harbin, China.

PMID: 38713846
DOI: 10.1097/PEC.0000000000003187

Abstract

Background: Intranasal fentanyl (INF) has gained popularity in pediatric emergency departments (EDs) as an effective alternative to intravenous morphine for treating acute moderate to severe pain. Intranasal fentanyl eliminates the need for invasive access, making it advantageous for patients with minor injuries. Our study aims to provide a comprehensive evaluation of the available evidence regarding the effectiveness and safety of INF administration in pediatric emergency wards, particularly compared with other treatment options described in the literature.

Methods: A thorough search strategy identified randomized controlled trials assessing INF in the pediatric emergency ward. Eligible studies were independently screened, and relevant data were extracted. The analysis used pooled risk ratio (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous ones. Randomized controlled trials' quality was assessed using the Cochrane Risk of Bias Assessment Tool 2.

Results: In our study, 8 randomized controlled trials involving 806 patients, INF demonstrated superior effectiveness in reducing pain compared with other comparators at the 15- to 20-minute mark (SMD, -0.23; 95% confidence interval, -0.37 to -0.08; P = 0.002). However, no significant differences were found at the 30- and 60-minute time points (SMDs, -0.16; 95% CI, -0.50, 0.19; P = 0.37; and -0.16; 95% CI, -0.50 to 0.19; P = 0.78) except when excluding one study to resolve heterogeneity at the 30-minute mark (RR, -0.02; 95% CI, -0.24 to 0.20; P = 0.87). Intranasal fentanyl also exhibited a better adverse outcome profile, with a lower risk of total adverse events and nausea/vomiting (RR, 0.66; 95% CI, 0.48-0.91; P = 0.01; and RR, 0.43; 95% CI, 0.30-0.63; P > 0.001) compared with other analgesics. However, no significant differences were observed for dizziness and hallucination (RR, 0.43; 95% CI, 0.30-0.63; P = 0.68; and RR, 0.43; 95% CI, 0.30-0.63; P = 0.35).

Conclusions: Our study assessed the effectiveness of INF compared with other analgesics in pain reduction. Intranasal fentanyl demonstrated superior pain reduction at the 15- to 20-minute point but showed no significant differences at 30 and 60 minutes. Intranasal fentanyl also had a more favorable adverse event profile, with a lower risk of nausea and vomiting than other analgesics. However, no significant differences were observed in dizziness and hallucination between the groups.