Intranasal diamorphine in adults with severe pain.
Date First Published:
August 15, 2003
Last Updated:
June 8, 2011
Report by:
M Azam Majeed, ST6 (Alexandra hospital, redditch)
Three-Part Question:
Is [intranasal diamorphine a suitable alternative] to [IV diamorphine in adults] presenting with [severe pain (>= 7/10) in ED].
Clinical Scenario:
A 68 yrs old female presents with Fracture neck of femur in ED after a fall and now in severe pain 10/10 and we couldn't get a line so IV morphine can be given, so would intranasal diamorphine be a suitable alternative?
Search Strategy:
Medline 1950- May 2011
embase 1980- May 2011
google
cochrane
embase 1980- May 2011
cochrane
Search Details:
intranasal diamorphine and adults
Outcome:
We found 4 papers and 2 to be relevant to answer our 3 part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A comparison of patient controlled analgesia administered by the intravenous or intranasal route during the early post operative period. Ward M, Minto G, Alexander-Williams JM. 2002, UK | 52 patients after total hip or knee replacement were randomly given IV or intra nasal diamorphine unblinded. | Randomized, non blinded, comparative study | Comparison of Intravenous diamorphine versus Intranasal diamorphine in pain control.. | Intranasal diamorphine resulted in higher pain score 35.5 vs 20 for Intravenous diamorphine (p=0.30)and on movement (Intransal median 64 vs Intravenous median 50 p=0.016) | Small number, single center, difference in the groups, selection bias, no power calculation. |
| Intranasal Diamorphine in Adults. Dooris B, Reid C, Gaunt D. 2001, UK | 57 yrs old female known chronic renal failure with deformed elbow. | Case report | To see if Intransal diamorphine was an effective alternative to Intravenous diamorphine in pain management. | With 0.1mg/kg intransal diamorphine they achieved immediate pain relief. | Case report, no statistical significance, weak level of evidence. |
Author Commentary:
There isn't enough evidence available in the literature to answer our question.
Bottom Line:
There isn't enough evidence to prove or disprove usage. A large randomized, double blinded multicenter trial will give the answer. The other reason for Intranasal diamorphine not being used for adults in UK is that it is not licensed for use in adults.
References:
- Ward M, Minto G, Alexander-Williams JM.. A comparison of patient controlled analgesia administered by the intravenous or intranasal route during the early post operative period.
- Dooris B, Reid C, Gaunt D.. Intranasal Diamorphine in Adults.