UMEM Educational Pearls

Category: Pediatrics

Title: Intranasal fentanyl (submitted by Ari Kestler, MD)

Keywords: sedation, pain management (PubMed Search)

Posted: 7/3/2013 by Mimi Lu, MD (Emailed: 7/26/2013) (Updated: 7/26/2013)
Click here to contact Mimi Lu, MD

Cringing at the thought of sewing up another screaming 2 year old?

Consider intranasal fentanyl.

Who: Young, otherwise healthy pediatric patients undergoing minor procedures (laceration repair, fracture reduction/splinting, etc...)

What: Fentanyl (2mcg/kg)

When: 5 minutes pre-procedure

Where: Intranasal

Why: More effective than PO, less invasive than IV while being equally efficacious.

How: Use an atomizer, splitting the dose between each nostril.


1) Use of Intranasal Fentanyl for the Relief of Pediatric Orthopedic Trauma Pain, Mary Saunders, MD Academic Emergency Medicine 2010, 17:1155-1161.
2) A Randomized Controlled Trial Comparing Intranasal Fentanyl to Intravenous Morphine for Managing Acute Pain in children in the Emergency Department, Meredith Borland, MBBS, FACEM, Annals of Emergency Medicine, March 2007, Vol. 49, No.3, 335-340
3) The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency
Department Reduces time to analgesic Administration, Anna Holdgate, MBBS, Academic Emergency Medicine 2010, 17:214-217.