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Diamorphine or fentanyl for intranasal analgesia in children?

Three Part Question

In [a child with a severe pain from an injury] is [intranasal diamorphine or intranasal fentanyl] more effective at [providing pain relief]?

Clinical Scenario

You are working in the Paediatric Emergency Department when a 7 year old child comes in who has fallen off a swing and has an obvious deformity to his forearm. Your department has recently introduced a protocol to give intranasal diamorphine for pain relief. However you have also read a paper from Australia advocating the use of intranasal fentanyl in this situation. You wonder if there is any evidence that one drug is more effective than the other.

Search Strategy

Medline via Ovid 1950 to week 4 January 2008
[exp diamorphine OR] AND [exp fentanyl OR]

Search Outcome

3 papers were found none of which were relevant to the question.


Both intranasal diamorphine and intranasal fentanyl have been shown to be safe and effective analgesic agents in the Paediatric Emergency Department. Each agent has been compared with morphine (either intravenous or intramuscular) in trials however they have never been compared with each other.

Clinical Bottom Line

There is insufficient evidence to recommend one treatment above another. Local guidelines should be followed.