Letter

Nasal diamorphine in children with clinical fractures

BMJ 2001; 322 doi: 10.1136/bmj.322.7298.1367 (Published 2 June 2001)
Cite this as: BMJ 2001;322:1367

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Patients should be told what to do when analgesia wears off

  1. Gail Eva, clinical lead occupational therapist (gaileva@themutual.net)
  1. Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital, Oxford OX3 7LJ
  2. University of Texas Southwestern, Dallas
  3. Guy's and St Thomas's NHS Trust, London SE1 7EQ
  4. St Thomas's Hospital, London SE1 7EH
  5. Emergency Department, Frenchay Hospital, Bristol BS16 1LE
  6. Clinical Effectiveness Unit, Royal College of Surgeons, London WC2A 3PE
  7. University College Clinical Research Network, Royal Free Hospital, London NW3 2QG

    EDITOR—Kendall et al report the advantages of nasal diamorphine.1 When my 5 year old son was recently admitted to an accident and emergency department with a fractured collarbone, nasal diamorphine was administered with all of the good effects that the authors described. But the effects wear off quite quickly. In our case, diamorphine was administered at 6 am and my son was supplied with a piece of triangular cotton and discharged home.

    By 10 am he was in severe pain, and for the following 12 hours or so he was extremely distressed. The combination of ibuprofen and paracetamol prescribed by the hospital was not adequate. When I rang the general practitioner to request something more effective I was told that she could not help; if we had a problem we should take him back to hospital. Even had I been able to face another six hour wait in the accident and emergency department this was impossible—he screamed when he moved. We persevered at home and worked on distraction.

    Nasal diamorphine is evidently effective, safe, and easy to administer. I would appeal to doctors using it for children in accident and emergency departments, however, to make adequate provision for after its effects have worn off.

    References

    1. 1.↵
      1. Kendall JM,
      2. Reeves BC,
      3. Latter VS
      .Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures.BMJ2001;322: 261–265. (3 February.)
      OpenUrlFREE Full Text

    Most interesting questions remain unanswered in this study

    1. Gregory Luke Larkin, visiting professor of surgery (gll42@hotmail.com),
    2. Peter Leman, consultant in emergency medicine
    1. Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital, Oxford OX3 7LJ
    2. University of Texas Southwestern, Dallas
    3. Guy's and St Thomas's NHS Trust, London SE1 7EQ
    4. St Thomas's Hospital, London SE1 7EH
    5. Emergency Department, Frenchay Hospital, Bristol BS16 1LE
    6. Clinical Effectiveness Unit, Royal College of Surgeons, London WC2A 3PE
    7. University College Clinical Research Network, Royal Free Hospital, London NW3 2QG

      EDITOR—We …

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