Delivering adequate analgesia in pediatric patients in a timely fashion is difficult. IV route requires staffing and produces additional pain and anxiety in this population. However, the oral route has a delayed onset. The benefit to IN fentanyl is that it can provide adequate control pain without IV access. Even if the patient still needs an IV for other reasons, IN fentanyl can be administered faster while the nurses are preparing the IV.
A paper in 2010 showed that 2 microgram/kg of IN fentanyl provides adequate analgesia in within 10 minutes of administration in pediatric patients with various orthopedic injuries.
How do we administer IN Fentanyl?
Step 1: Draw up 1-2 microgram/kg of fentanyl in a syringe.
Step 2: Connect the syringe to a mucosal atomization device
Step 3: Push < 0.3 cc in each nare at a time, because this volume is easily tolerated. If you are using a larger volume, you can repeat the process.
Saunders, M., Adelgais, K. and Nelson, D. Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2010;17(11):1155-1161.