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In the emergency department (ED), nonopioid analgesics may be preferred over opioids for the treatment of acute pain in children. To determine if intranasal ketamine would be as safe and effective as intranasal fentanyl for managing moderate-to-severe pain in this setting, researchers performed a systematic review and meta-analysis of 4 randomized trials that compared the two drugs in 276 children treated in the ED for acute pain resulting mainly from extremity injuries. Patients received ketamine (1.0–1.5 mg/kg) or fentanyl (1.5–2.0 μg/kg). Studies involving dissociative dosing of ketamine or patients with chronic pain conditions (e.g., sickle cell disease) were excluded. Risk for bias was assessed as low in the studies.
Pain reduction was …