References
Intranasal analgesia for prehospital management of children in pain

Abstract
Background:
Prehospital management of pain in children could be considered substandard, with not all children in pain receiving adequate and timely analgesia. With intravenous access being difficult to obtain and many children displaying a fear of needles, the common barrier highlighted is the route of easily administered analgesia.
Aims:
To explore the use of intranasal analgesia for the management of children in pain in the prehospital environment.
Methods:
A search was completed using One Search and EBSCOhost research interface of the CINAHL Plus database. This scoping review identified literature on the chosen topic of interest, which was then refined to six studies exploring three key themes: efficacy, safety and feasibility.
Results:
621 children were included across the six studies, receiving either morphine, diamorphine, ketamine or fentanyl. Similar efficacy was seen between morphine and fentanyl, as well as fentanyl and ketamine. Adverse events were more prevalent in the ketamine groups; however, these were considered minor, and no serious adverse events were recorded. Sedation levels were not thought to be significant and could be considered advantageous in this patient group.
Conclusion:
Intranasal drug administration provides an efficacious route that is non-invasive and safe to administer in challenging environments. A sub-dissociative dose of ketamine is as efficacious as fentanyl, while offering a non-opioid alternative.
Pain is described as an unpleasant awareness of actual or potential tissue damage (Raja et al, 2020) and is the most common presenting condition to emergency departments (Krauss et al, 2016). Prehospital management of children's pain, of medical and traumatic aetiology, is considered substandard (Hartshorn et al, 2022), with Gai et al (2020) acknowledging that there are many reasons why children in pain are so under-treated. The present scoping review aims to consider intranasal (IN) analgesia for prehospital management of children's pain by reviewing the efficacy, safety and feasibility of the IN route by paramedics.
Assessment of children in pain is challenging – especially when considering the diversity of age, gender and development. Pancekauskaitė and Jankauskaitė (2018) highlighted that insufficient training, personal bias and incorrect use of pain-scoring tools can also provide barriers to effective assessment. Gai et al (2020) emphasise that there is little evidence to support the use of one pain-scoring tool over another, and these should be used alongside patient assessment, clinical observations and feedback from family.
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