Use of Intranasal Analgesia for Acute Pain in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
In brief
In 1,388 children, no nasal or IV analgesic beat nasal fentanyl for pain
In 15 randomized trials, no intranasal or intravenous option reduced children's pain more than intranasal fentanyl at any measured time, and the need for rescue medicine was similar. Intranasal ketamine caused more adverse events, mostly mild and brief; high acceptability across treatments supports nasal analgesia as an option, but the best choice for individual patients remains unclear.
- Journal
- Pain research & management (Q1)
- Published
- 1 January 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mohammed Alsabri, Yahya A Mahmoud, Shree Rath, Eslam Abady, Mohamed Ashraf Shehab, Raseel Sleem, et al.
- PMID
- 42895051
- DOI
- 10.1155/prm/1894053
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 21 October 2026): Systematic review and network meta‑analysis of intranasal analgesia in pediatric
Abstract
BACKGROUND: Pain is one of the most common reasons for presentation to pediatric emergency departments, yet timely and effective analgesia remains inconsistently delivered. Intranasal (IN) analgesics offer a noninvasive alternative to injectable routes, but their comparative effectiveness, safety, and acceptability across agents and routes remain incompletely defined. METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0-18 years presenting to emergency or prehospital settings. Eligible trials compared IN agents with alternative IN formulations, intravenous, intramuscular, oral analgesics, or placebo. Pain reduction measured using validated pediatric pain scales at predefined timepoints was the primary outcome. Secondary outcomes included need for rescue analgesia, adverse events, acceptability, and emergency department length of stay. FINDINGS: Fifteen randomized controlled trials involving 1388 pediatric patients were included. Across all evaluated timepoints, including the primary outcome and assessments at 10, 15, 20, 30, and 60 min, no IN or intravenous analgesic demonstrated statistically superior pain reduction compared with IN fentanyl. Requirements for rescue analgesia were similarly comparable across treatments. IN ketamine was associated with a significantly higher risk of adverse events compared with standard-dose IN fentanyl, although events were predominantly mild and transient. Acceptability among patients, caregivers, and providers was high across IN agents, and available data indicated no clinically meaningful differences in emergency department length of stay.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.