BMJ 2001;322:261-265 ( 3 February )

Papers

Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures

Jason M Kendall, consultant, a Barnaby C Reeves, director, b Victoria S Latter, manager, c on behalf of the Nasal Diamorphine Trial Group.

a Emergency Department, Frenchay Hospital, Bristol BS16 1LE, b Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PN, c University College London Clinical Research Network, Royal Free Hospital, London NW3 2QG

Correspondence to: J M Kendall frenchayed{at}cableinet.co.uk

Objective: To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray.
Design: Multicentre randomised controlled trial.
Setting: Emergency departments in eight UK hospitals.
Participants: Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb.
Main outcome measures: Patients' reported pain using the Wong Baker face pain scale, ratings of reaction to treatment of the patients and acceptability of treatment by staff and parents, and adverse events.
Results: 404 eligible patients completed the trial (204 patients given nasal diamorphine spray and 200 given intramuscular morphine). 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. 80% of patients given the spray showed no obvious discomfort compared with 9% given intramuscular morphine (difference 71%, 95% confidence interval 65% to 78%). Treatment administration was judged acceptable by staff and parents, respectively, for 98% (199 of 203) and 97% (186 of 192) of patients in the spray group compared with 32% (64 of 199) and 72% (142 of 197) in the intramuscular group. No serious adverse events occurred in the spray group, and the frequencies of all adverse events were similar in both groups (spray 24.1% v intramuscular morphine 18.5%; difference 5.6%, -2.3% to 13.6%).
Conclusion: Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures. The diamorphine spray should be used in place of intramuscular morphine.


© BMJ 2001
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Pain management and sedation for children in the emergency department
Paul Atkinson, Adam Chesters, and Peter Heinz
BMJ 2009 339: b4234. [Extract] [Full Text]

Nasal diamorphine in children with clinical fractures
Gail Eva, Gregory Luke Larkin, Peter Leman, J M Kendall, B C Reeves, and V S Latter
BMJ 2001 322: 1367. [Extract] [Full Text]

Nasal diamorphine eases pain after fractures faster than intramuscular morphine
BMJ 2001 322: 0. [Full Text]

This article has been cited by other articles:

  • Telfer, P, Criddle, J, Sandell, J, Davies, F, Morrison, I, Challands, J (2009). Intranasal diamorphine for acute sickle cell pain. Arch. Dis. Child. 94: 979-980 [Abstract] [Full text]  
  • Kidd, S, Brennan, S, Stephen, R, Minns, R, Beattie, T (2009). Comparison of morphine concentration-time profiles following intravenous and intranasal diamorphine in children. Arch. Dis. Child. 94: 974-978 [Abstract] [Full text]  
  • Atkinson, P., Chesters, A., Heinz, P. (2009). Pain management and sedation for children in the emergency department. BMJ 339: b4234-b4234 [Full text]  
  • Bizos, K, Smith, S M (2009). Attention to detail for children in pain. Emerg. Med. J. 26: 684-684 [Full text]  
  • Harrop, J E. (2007). Management of pain in childhood. EDUCATION AND PRACTICE 92: ep101-ep108 [Full text]  
  • Harvey, A. J, Morton, N. S (2007). Management of procedural pain in children. EDUCATION AND PRACTICE 92: ep20-ep26 [Full text]  
  • Benger, J (2006). "Brutacaine" vanquished, but pain remains.. Emerg. Med. J. 23: 823-823 [Full text]  
  • Loryman, B, Davies, F, Chavada, G, Coats, T (2006). Consigning "brutacaine" to history: a survey of pharmacological techniques to facilitate painful procedures in children in emergency departments in the UK.. Emerg. Med. J. 23: 838-840 [Abstract] [Full text]  
  • Jewkes, F. (2004). Paediatric prehospital trauma. Trauma 6: 121-133 [Abstract]  
  • Hall, E J, Sykes, N P (2004). Analgesia for patients with advanced disease: I. Postgrad. Med. J. 80: 148-154 [Abstract] [Full text]  
  • Allison, K, Porter, K (2004). Consensus on the prehospital approach to burns patient management. Emerg. Med. J. 21: 112-114 [Abstract] [Full text]  
  • Allison, K., Porter, K. (2003). Consensus on the prehospital approach to burns patient management. Trauma 5: 97-101 [Abstract]  
  • Price, C J S, Spalding, T J W, McKenzie, C, Farquharson-Roberts, M (2002). Patterns of illness and injury encountered in amateur ocean yacht racing: an analysis of the British Telecom Round the World Yacht Race 1996-1997 * Commentary. Br. J. Sports. Med. 36: 457-462 [Abstract] [Full text]  
  • Davies, M., Crawford, I. (2001). Nasal diamorphine for acute pain relief in children. Emerg. Med. J. 18: 271-271 [Full text]  
  • Eva, G., Larkin, G. L., Leman, P., Kendall, J M, Reeves, B C, Latter, V S (2001). Nasal diamorphine in children with clinical fractures. BMJ 322: 1367-1367 [Full text]  
  • (2001). Nasal Diamorphine Gives Quick Pain Relief to Children with Fractures. JWatch Emergency Med. 2001: 9-9 [Full text]  
  • (2001). Nasal Diamorphine for Analgesia in Children. JWatch General 2001: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

When the analgesia wears off...
Gail Eva
bmj.com, 3 Feb 2001 [Full text]
Intramuscular analgesia is out of vogue
M A Chaudhry
bmj.com, 4 Feb 2001 [Full text]
Nasal rote may not be the best
N G Mandal
bmj.com, 6 Feb 2001 [Full text]
Randomised to Sniffing Heroin
Claudius Rudin
bmj.com, 6 Feb 2001 [Full text]
Don't forget to splint injured limbs.
Roderick Duncan
bmj.com, 6 Feb 2001 [Full text]
Duration of analgesia
Vince Summers
bmj.com, 6 Feb 2001 [Full text]
Is intramuscular morphine a good outcome for comparison?
Vicente Ruiz-Garcia
bmj.com, 7 Feb 2001 [Full text]
More questions than answers
Norbert Klöcker
bmj.com, 9 Feb 2001 [Full text]
IM injections hurt - but is intranasal diamorphine better than current practice?
Gregory Larkin
bmj.com, 14 Feb 2001 [Full text]
Diamorphine in children Really ?
Axel Schnuch
bmj.com, 19 Feb 2001 [Full text]
Re: Diamorphine in children.
Theo Fenton
bmj.com, 20 Feb 2001 [Full text]
Use of nasal diamorphine for analgesia in children and teenagers
Eric A Voth, et al.
bmj.com, 25 Apr 2001 [Full text]
Nasal Diamorphine as an analgesic agent - response from authors
Jason Kendall
bmj.com, 10 May 2001 [Full text]
The pharmacokinetics of intranasal diamorphine
James Robert Craig
bmj.com, 1 Jun 2001 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ