Marianne Segerberg1, Anders Lindberg1, Katharina Lundkvist1, Stefan Lundeberg1
1) Sweden
Procedural pain is a challenge in pediatric care. The procedural pain itself, like change of burn dressings, is often quite intense. Pharmacological treatment is an important part of the multimodal and multidisciplinary caretaking. In situations when the patient is lacking an intravenous line it is a possibility to use intranasal administration of analgesics and by choosing this alternative a stressful and to a certain degree a painful placement of an intravenous line can be avoided.
At our Pain Treatment Service we have been using a potent opioid intranasally administered as the prime analgesic with good efficacy in more than 2000 children. Sufentanil (50 microg/ml) is administered as a nasal spray with Mucosal Atomizing Device (Wolfe Tory Inc). The drug is not giving any discomfort by itself, is odorless and well accepted by the child. The effect of sufentanil is quite prominent and in our experience more predictable than intranasal fentanyl. The effect of sufentanil is dose dependent and used in higher doses require competent personal to ensure vital functions of the patient even though we seldom have problems with serious respiratory depression.
Sufentanil as an opioid is a good analgesic but also causes sedation. In many procedures pain is not a problem in the post-procedure phase. In order for providing an optimal situation, in especially outpatients, we have since 10 years back used intranasal naloxone to reverse the effect of sufentanil. The clinical effect is notable after about 10-15 minutes after administration of naloxone. This is well in line with the pharmacological findings in a study (submitted for publication) in healthy volunteers who received naloxone intranasally. We are presently confirming our clinical experiences with an ongoing pharmacological and pharmadynamic study in children and plan to publish data in the near future.
The authors have no conflict of interest to declare.
