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Pain management for children in the emergency department frequently is inadequate, often because clinicians are hesitant to start an intravenous line to administer pain medications. In a randomized, unblinded trial, researchers compared the efficacy of fentanyl administered by breath-activated nebulizer with fentanyl administered intravenously.
A convenience sample of 41 children aged 6 months to 17 years who presented to a single ED with acute pain were randomized to receive either IV fentanyl (1.5 μg/kg) or nebulized fentanyl (3 μg/kg in normal saline to a total volume of 5 mL). Four of 14 children randomized to the IV group received nebulized fentanyl because parents requested it after being informed of their child’s assignment to the IV …