Intranasal Ketamine Noninferior to Intranasal Fentanyl for Pediatric Pain

Intranasal ketamine has been compared with intranasal fentanyl for pain reduction in the emergency department, but previous studies had important limitations.

Researchers randomized 90 patients aged 8–17 years presenting to one pediatric hospital's emergency department with moderate-to-severe pain from an acute limb injury to receive either intranasal ketamine (1.5 mg/kg) or intranasal fentanyl (2 mcg/kg). The primary outcome was the difference between groups in mean pain reduction on the visual analog scale (range, 1–100 mm) from baseline to 30 minutes after treatment.

Mean pain reduction was similar between groups at 30 minutes (ketamine, −31 mm; fentanyl, −32 mm); ketamine was shown to be statistically noninferior. Rescue analgesia rates w…