The beauty of intranasal is that the effect is within a few minutes and
gives time for EMLA/Ametop to work, allowing relatively pain-free
cannulation in children who are already in pain, anxious and frightened.
Agreed the comparator was IM, but why put children through another trial
to look at IV v IN when we know that IN works and allows reduction of
the factors already mentioned? I have IN numerous times and know what I
would want for my kids if they ever broke anything!

Simon Odum

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Boyle
Sent: 13 April 2004 09:35
To: [log in to unmask]
Subject: Re: Intranasal Morphine

Ah but the problem in this trial was the comparator. This very well
conducted trial showed that intra-nasal diamorphine was better than
intra-muscular morphine. I haven't used intramuscular morphine in
children
for years. The trial that needs to be done in hospital is comparing iv
morphine with intra-nasal diamorphine, I really don't know which would
be
better. The problem, I guess, is that many SHOs feel a little insecure
about
cannulating children and tend to use the easiest method.


-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Fiona Jewkes
Sent: Saturday, April 10, 2004 2:22 PM
To: [log in to unmask]
Subject: Re: Intranasal Morphine


It's very good - Jason Kendall did a big study on it a few years ago in
Bristol. The problem for Paramedics is the POM exemption legalities. IV
morphine is not licensed for use in children at present (long story) but
after 2 years of wrangling with the MHRA (the MCA as was) they agreed we
could use it as an extension of the adult licence. (Note we have used
this
ruling  too for Chlorpenamine for children in the V3 Guidelines). The
problem for intranasal opiates are that they are not licensed for use in
adults either and PGDs cannot be used for controlled drugs like
morphine. I
would dearly like to see intranasal morphine or diamorph available for
paramedics but at present it would be illegal. When the next POM
exemption
requests go in though I'm sure we should make a case for it, though for
an
unlicensed drug with very little prehospital research (there is some for
fentanyl from Australia) it is far from a foregone conclusion whether it
would be approved. I would investigate oramorph in the meantime, which
is
licensed. Sorry - it's all very easy for docs in hospital who can pretty
much give what they want.

Fiona Jewkes
JRCALC Guidelines representative
Royal College of Paediatrics and Child Health
----- Original Message -----
From: "Richard Taffler" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, April 11, 2004 11:27 PM
Subject: Intranasal Morphine


>             I treated two children (9&11) in significant pain from
isolated
> limb fractures (one wrist, one ankle) yesterday. They refused to even
> entertain anything to do with a needle, ruling out Nubain, and entonox
> barely controlled their pain. However, both received intranasal
diamorph
on
> admission to our local A&E, which they tolerated very well, and
received
> significant analgesia. We are already licensed to give morphine IV to
> children from 1 year, is it suitable to be administered intranasal? If
> anyone could point me in the direction of some evidence, I would be
very
> grateful.
>
>
>
> Many Thanks
>
>
>
> Richard Taffler
>
> BSc(Hons) BEng SRPara
>
>

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