Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department Emergency Medicine Journal, 04/03/2012

Regan L et al. – The authors found no significant difference in time to administration of analgesia between agents, but a learning curve has been identified. Sustained effort should be placed on the use of simple coanalgesia. The clinical performance of Intranasal diamorphine (IND) compares favourably with intravenous morphine (IVM) in children with severe pain, and it remains an appropriate preferred agent.

• IND was introduced to the Royal Aberdeen Children's Hospital on 24 December 2009.
• A retrospective case series was constructed to compare its clinical performance with its predecessor IVM.
• Three unexplored factors were investigated: time to opiate analgesia, the requirement for further analgesia when still in the emergency department and the effect of simple coanalgesia (eg, paracetamol/ibuprofen) on these requirements.

• 297 patients were eligible for the study (147 IND, 150 IVM) over a 28–month period.
• There was a non–significant trend to a longer median time to administration of analgesia in patients receiving IND (p=0.170).
• Patients who received IND were less likely to require further analgesia (p<0.001).
• Both groups were less likely to require further analgesia when simple coanalgesia was given (p=0.049).