heroin and Fractures--Bone

Current best practice for treating acute severe pain in children is to administer intravenous or intranasal opioid. Intranasal diamorphine offers less traumatic analgesia than the potentially difficult and distressing intravenous route. However, there has been no direct comparison of intranasal and intravenous diamorphine nor are there pharmacokinetic data for intranasal diamorphine in children.. To compare plasma morphine concentration-time profiles following intranasal and intravenous diamorphine administration.. Observational.. A&E department in a city-centre paediatric teaching hospital.. Children, aged 3-13 years, with isolated limb fracture.. An intravenous catheter was sited and baseline blood taken. The first 12 children received intravenous diamorphine (0.1 mg/kg), and the subsequent 12 intranasal diamorphine (0.1 mg/kg) in 0.2 ml sterile water drops. Subsequent samples were taken at 2, 5, 10, 20, 30 and 60 min.. Plasma morphine radioimmunoassay.. Peak plasma morphine concentrations were higher (median 109 vs 36 nmol/l), and occurred earlier (median 2 vs 10 min), with greater area under the curve (3761 vs 1794 nmol/l/h) following intravenous compared to intranasal diamorphine (all p<0.001, Mann-Whitney U test). Higher plasma concentrations at 60 min (47 vs 32 nmol/l) were also observed following intravenous diamorphine (p = 0.01, Mann-Whitney U test).. Our evidence supports the wider use of diamorphine administration by nasal drops in children, as it shows that adequate plasma levels of morphine are usually achieved. However, we demonstrated significantly attenuated and delayed peak plasma morphine levels with lower levels at 1 h with intranasal compared with intravenous diamorphine.

Topics: Administration, Intranasal; Adolescent; Analgesics, Opioid; Child; Child, Preschool; Drug Administration Schedule; Emergency Service, Hospital; Female; Fractures, Bone; Heroin; Humans; Injections, Intravenous; Male; Morphine; Pain; Time Factors

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.. Multicentre randomised controlled trial.. Emergency departments in eight UK hospitals.. Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb.. 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.. 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%).. 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.

Topics: Administration, Intranasal; Adolescent; Analgesics, Opioid; Child; Child, Preschool; Emergencies; Female; Fractures, Bone; Heroin; Humans; Injections, Intramuscular; Male; Morphine; Pain; Pain Measurement; Patient Satisfaction; Time Factors

To evaluate the safety and efficacy of intranasal diamorphine as an analgesic for use in children in accident and emergency (A&E).. A prospective, randomised clinical trial with consecutive recruitment of patients aged between 3 and 16 years with clinically suspected limb fractures. One group received 0.1 mg/kg intranasal diamorphine, and the other group received 0.2 mg/kg intramuscular morphine. At 0, 5, 10, 20, and 30 minutes pain scores, Glasgow coma score, and peripheral oxygen saturations were recorded; parental acceptability was assessed at 30 minutes.. 58 children were recruited, with complete data collection in 51 (88%); the median summed decrease in pain score was better for intranasal diamorphine than intramuscular morphine (9 v 8), though this was not significant (P = 0.4, Mann-Whitney U test). The episode was recorded as "acceptable" in all parents whose child received intranasal diamorphine, compared with only 55% of parents in the intramuscular morphine group (P < 0.0001, Fisher's exact test). There was no incidence of decreased peripheral oxygen saturation or depression in the level of consciousness in any patient.. Intranasal diamorphine is an effective, safe, and acceptable method of analgesia for children requiring opiates in the A & E department.

Topics: Administration, Intranasal; Adolescent; Analgesics, Opioid; Child; Child, Preschool; Fractures, Bone; Heroin; Humans; Injections, Intramuscular; Morphine; Pain Measurement; Prospective Studies

Topics: Administration, Intranasal; Adult; Analgesics, Opioid; Emergency Medicine; Evidence-Based Medicine; Female; Fentanyl; Fractures, Bone; Heroin; Humans; Infusions, Intravenous; Joint Dislocations; Morphine; Pain

Topics: Administration, Intranasal; Analgesics, Opioid; Child, Preschool; Clavicle; Fractures, Bone; Heroin; Humans; Male; Pain; Secondary Prevention

Topics: Administration, Intranasal; Adolescent; Age Factors; Analgesics, Opioid; Child; Child, Preschool; Emergencies; Evidence-Based Medicine; Fractures, Bone; Heroin; Humans; Male; Morphine; Radius Fractures; Ulna Fractures