From the Research
The recommended pediatric intranasal dose of fentanyl is 1.5 micrograms per kilogram of body weight. This dose is supported by the most recent and highest quality study, which demonstrated the safety and efficacy of intranasal fentanyl in children with acute pain 1. The study found that a dose of 1.5 micrograms per kilogram was effective in reducing pain in children, with a significant reduction in pain scores at 10 minutes after administration.
Key Considerations
- The dose should not exceed a maximum single dose of 100 micrograms.
- The medication should be administered using a mucosal atomization device to ensure proper distribution across the nasal mucosa for optimal absorption.
- When preparing the dose, use the standard concentration of 50 micrograms per milliliter, and divide the total dose equally between both nostrils if the volume exceeds 0.5 mL.
- Intranasal fentanyl is particularly useful for acute pain management in children when intravenous access is difficult or unavailable.
Administration and Monitoring
- The onset of action is rapid, typically within 5-10 minutes, with a duration of approximately 30-60 minutes.
- Monitor the child closely for respiratory depression, especially in younger patients or those with underlying respiratory conditions.
- Have naloxone readily available as a reversal agent if needed, as it can quickly counteract the effects of fentanyl in case of an overdose or severe respiratory depression 1.
Evidence Summary
The evidence from the studies 2, 3, 4, 1, 5 consistently supports the use of intranasal fentanyl for acute pain management in children, with a dose of 1.5 micrograms per kilogram being the most commonly recommended and effective dose. However, the most recent and highest quality study 1 is given priority in making this recommendation, as it provides the most up-to-date and reliable evidence on the safety and efficacy of intranasal fentanyl in children.