[log in to unmask] wrote:
>
> Can anyone let me have a good recent reference regarding the use of intra-nasal
> diamorphine?
> Thanks
> Nick Jenkins
> A&E Consultant, Abergavenny
> http://www.dingle-dell.demon.co.uk/index.html
Nick,
There is only one study in the literature using intra-nasal diamorphine
as an analgsiec agent in children; that is a pilot study done at
Frenchay (ref. JAEM 1997; 14(2):70-72). The pilot we did showed good
efficacy and no unwanted side effects, but in a small number of children
(approx 30 in each group). Following this pilot I am running a southwest
regional multicentre RCT to further evaluate the efficacy and safety
profile of intra-nasal diamorphine (360 out of a target sample of 400
recruited to date - recruitment almost complete). I hope to have the
results published as soon as possible. Experience so far is very
encouraging - profound and rapid analgesic and mild anxiolitic effect
without unwanted side effects (respiratory or conscious level
depression). Ideal for use in any child in moderate to severe acute pain
(orthopaedic injury, minor burns, finger tip injuries...).
Intranasal diamorphine is not a sedative and therefore may not be
suitable for use in suturing children; we have found a combination of
oral ketamine (RCT vs oral midazolam submitted to JAEM, 1999) with
topical adrenaline cocaine (JAEM 1996; 13(2):119-23) as local
anaesthetic an excellent combination. The intranasal route (particularly
for midazolam where volumes of administration are large) offers no
particular advantage over the oral route in procedures such as suturing
which require no great urgency. This is in contrast to the need for
analgesia where time is of the essence.
Jason Kendall,
Consultant in Emergency Medicine.
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