Abstract
Objectives
We aimed to describe the analgesic efficacy, duration of analgesia, and adverse event
profile associated with intranasal hydromorphone in children with acute pain presenting
to an emergency department.
Methods
Prospective dose titration pilot study of otherwise healthy children 4 to 17-years-old
with moderate to severe pain who required a parenteral opioid. All patients received
an initial intranasal hydromorophone dose of 0.03 mg/kg. The need for additional analgesia
was assessed at 15 and 30 min; an additional 0.015 mg/kg was given at each assessment,
if required. Need for rescue analgesic, pain intensity and adverse events were assessed
until 6 h after hydromorphone administration or until patients were discharged, underwent
a procedure to treat their painful condition, or received a rescue analgesic.
Results
We enrolled 35 children. Fifteen, 11, and 9 children required a total dose of 0.03,
0.045, and 0.06 mg/kg, respectively. Patients in each dose group experienced an absolute
decrease in pain score of ≥3/10 and percent reduction >40% within 5–15 min of completing
dose-titration administration of hydromorphone. Duration of analgesia (i.e. time until
rescue analgesic administered) >1 h was observed in 85.7% of patients. Patients not
requiring rescue analgesics had mild or no pain until discharged or their painful
conditions were treated. Three (8.6%) patients required a rescue analgesic <1 h after
hydromorphone administration. There were no major adverse events.
Conclusions
Intranasal hydromorphone led to rapid, clinically significant and frequently sustained
decreases in pain intensity in children. No major adverse events were observed in
this preliminary sample.
Clinical Trials Registration Number: NCT02437669
Keywords
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Article Info
Publication History
Published online: March 12, 2019
Accepted:
March 8,
2019
Received in revised form:
March 7,
2019
Received:
February 5,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
