Additive Value of Intranasal Fentanyl on Ibuprofen for Pain Management of Children With Moderate to Severe Headaches: A Randomized Controlled Trial

Abstract

BackgroundFew studies have evaluated the rapid pain improvement provided by medications for children presenting to an emergency department (ED) with headaches. ObjectiveOur aim was to evaluate pain reduction provided by intranasal fentanyl (INF) compared with placebo in addition to ibuprofen. MethodsA single-center, double-blinded, randomized, placebo-controlled clinical trial was conducted in a tertiary care pediatric ED. All children aged 8–17 years presenting with a moderate to severe headache were eligible. Study participants were randomly allocated to receive INF 1.5 µg/kg (maximum dose of 100 µg) or similar placebo solution. Co-administration of oral ibuprofen 10 mg/kg (maximum dose of 600 mg) was also provided. The primary outcome was the mean pain rating reduction at 15 min. ResultsAmong the 62 participants, the median age was 14 years (interquartile range [IQR] 12–16 years in both groups) and the median initial visual analog scale (VAS) score was 64 (IQR 55–72 in the intervention group; IQR 50–81 in the control group). There was no difference in the mean pain score reduction at 15 min between the two groups (mean difference 2 mm; 95% CI –7 to 11 mm). Mean VAS score reductions were also similar at 30 and 60 min. Adverse events were more frequent in the INF group (risk ratio 2.8; 95% CI 1.29 to 6.22), but all events were minor and transient. No significant differences were found in other outcomes. ConclusionsThis study did not find a benefit from INF for providing additional pain relief in children presenting to ED with headaches.