Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures
Nasal diamorphine spray is a safe and effective method of pain relief for young people in acute pain with a limb fracture, and should be used in place of morphine by intramuscular injection, finds a study in this week's BMJ.
Kendall and colleagues identified 404 patients, aged between 3 and 16 years, attending an emergency department with acute pain resulting from a limb fracture. 204 patients were given nasal diamorphine spray and 200 were given intramuscular morphine. They found that onset of pain relief was faster in the spray group than in the intramuscular group, with lower pain scores in the spray group at 5, 10 and 20 minutes after treatment, but no difference between the groups after 30 minutes. Furthermore, 80% of patients given the spray showed no obvious discomfort compared with 9% given intramuscular morphine, and no serious adverse events were seen in patients given the spray.
There should no longer be any reason to give intramuscular morphine to such children because the spray is appropriate wherever intramuscular morphine is being considered, conclude the authors.
Contact:
Jason Kendall, Consultant, Emergency Department, Frenchay Hospital, Bristol, UK Email: frenchayed@cableinet.co.uk