ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 56
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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Intranasal analgesia for acute moderate to severe pain in
children – a systematic review and meta-analysis
Dr Bjarne Austad1, Marcus Glenton Prescott1,2, Ekaterina Iakovleva6, Sindre A Pedersen3,
Daniel Munblit4, Odd-Martin Vallersnes5,8, Melanie Rae Simpson7
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General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and
Health Sciences, Norwegian University of Science and Technology (NTNU), 2Emergency Department,
St. Olavs University Hospital, 3Library Section for Medical and Health Sciences, NTNU, 4Inflammation,
Repair and Development Section, National Heart and Lung Institute, Imperial College, London, 5Oslo
Municipal Out of Hours Primary Care Service, 6Department of Pediatrics and Pediatric Infectious
Diseases, Sechenov First Moscow State Medical University, 7Department of Public Health and
Nursing, Faculty of Medicine and Health sciences, NTNU, 8Department of General Practice, University
of Oslo
Importance
Children in acute pain often receive inadequate pain relief, partly from difficulties administering
injectable analgesics. A rapid-acting intranasal analgesic may be an alternative.
Objective
To compare the efficacy, safety and acceptability of intranasal analgesia to intravenous and
intramuscular administration; and to compare different intranasal agents.
Data sources
Cochrane Library, MEDLINE/PubMed, Embase, Web of Knowledge, ClinicalTrials.gov, Controlled-trials.
com/mrcr, Clinicaltrialsregister.eu, Apps.who.int/trialsearch. We screened reference lists of included
trials and relevant systematic reviews.
Data extraction and synthesis
Two authors independently assessed all studies. We included randomised trials of children aged 0–16
years, with moderate to severe pain; comparing intranasal analgesia to intravenous or intramuscular
analgesia, or to other intranasal agents. We excluded studies of procedural sedation or analgesia. We
extracted study characteristics and outcome data and assessed risk of bias with the ROB 2.0 tool. We
conducted a meta-analysis and narrative review, evaluating the certainty of evidence using GRADE.
Main outcomes and measures
Outcomes included pain reduction, adverse events, acceptability, rescue medication, ease of and time
to administration.
Results
12 RCTs were included with totally 1163 children aged 3–20 years, most below 10 years, with various
conditions.
There may be little or no difference in pain relief, adverse events, or acceptability between intranasal
and intravenous analgesia (low certainty evidence).
Intranasal diamorphine or fentanyl probably give similar pain relief to intramuscular morphine, and are
probably more acceptable and tolerated better (moderate certainty); adverse events may be similar
(low certainty).
Intranasal ketamine gives similar pain relief to intranasal fentanyl while having a higher risk of light
sedation and mild side effects (high certainty). Need for rescue analgesia is probably similar (moderate
certainty), and acceptability may be similar (low certainty).
Conclusions/relevance
Intranasal analgesics are probably a good alternative to intramuscular analgesics in children with acute
moderate to severe pain; and may be an alternative to intravenous administration.
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