Intranasal Fentanyl for Pain Management in Children: A Systematic Review of the Literature


      Intranasally administered fentanyl (INF) has been studied as an alternate route of delivery for pain relief in children. The purpose of this systematic review is to evaluate the available research evidence on the use of INF in the pediatric population. A search was conducted of PubMed, ISI, Scopus, Popline, CINAHL, and Embase for research studies evaluating INF in this population (0-18 years of age). The studies were graded on the strength of the evidence and the results reviewed. All of the reviewed studies showed similar or improved pain scores when compared with other opioids and administration methods. No severe adverse outcomes were reported. Current evidence suggests that INF is a safe and effective method of pain management for children in a variety of clinical settings.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Health Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. (2005). Acute pain management: Scientific evidence (Australian Government-National Health and Medical Research Council No. 2). Retrieved from

        • Borland M.L.
        • Bergesio R.
        • Pascoe E.M.
        • Turner S.
        • Woodger S.
        Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: A randomised double blind crossover study.
        Burns. 2005; 31: 831-837
        • Borland M.L.
        • Clark L.J.
        • Esson A.
        Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department.
        Emergency Medicine Australasia. 2008; 20: 515-520
        • Borland M.L.
        • Jacobs I.
        • Geelhoed G.
        Intranasal fentanyl reduces acute pain in children in the emergency department: A safety and efficacy study.
        Emergency Medicine. 2002; 14: 275-280
        • Borland M.
        • Jacobs I.
        • King B.
        • O'Brien D.
        A randomized controlled trial comparing intranasal fentanyl ot intravenous morphing for managing acute pain in children in the emergency department.
        Annals of Emergency Medicine. 2007; 49: 335-340
        • Cole J.
        • Shepherd M.
        • Young P.
        Intranasal fentanyl in 1-3-year olds: A prospective study of the effectiveness of intranasal fentanyl as acute analgesia.
        Pediatric Emergency Medicine. 2009; 21: 395-400
        • Crellin D.
        • Ling R.X.
        • Babl F.E.
        Does the standard intravenous solution of fentanyl (50mcg/mL) administered intranasally have analgesic efficacy.
        Pediatric Emergency Medicine. 2010; 22: 62-67
        • Cummings E.A.
        • Reid G.J.
        • Finley G.A.
        • McGrath P.J.
        • Ritchie J.A.
        Prevalence and source of pain in pediatric inpatients.
        Pain. 1996; 68: 25-31
        • Dooks P.
        Diffusion of pain management research into nursing practice.
        Pain Management Research. 2001; 24: 99-103
        • Finkel J.C.
        • Hannallah R.S.
        • Patel K.M.
        • Kim M.S.
        • Hummer K.A.
        • Choi S.S.
        • Zalzal G.
        • et al.
        The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement.
        Pediatric Anesthesia. 2001; 92: 116
        • Finn J.
        • Wright J.
        • Fong J.
        • Mackenzie E.
        • Wood F.
        • Leslie G.
        • Gelavis A.
        A randomized crossover trial of patient controlled intranasal fentanyl and oral morphine for procedural wound care in adult patients with burns.
        Burns. 2004; 30: 262-268
      2. Food and Drug Administration. (2002). Anesthetic and life support drugs advisory committee. Retrieved from

        • Friedland L.R.
        • Pancioli A.M.
        • Duncan K.M.
        Pediatric emergency department analgesic practice.
        Pediatric Emergency Care. 1997; 13: 103-106
        • Friedrichsdorf S.J.
        • Kang T.I.
        The management of pain in children with life-limiting illnesses.
        Pediatric Clinics of North America. 2007; 54: 645-672
        • Galinkin J.L.
        • Fazi L.M.
        • Cuy R.M.
        • Chiavacci R.M.
        • Kurth C.D.
        • Shah U.K.
        • Watcha M.F.
        • et al.
        Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia.
        Anesthesiology. 2001; 93: 1378-1383
        • Goldman R.D.
        Intranasal drug delivery for children with acute illness.
        Current Drug Therapy. 2006; 1: 127-130
        • Grape S.
        • Schug S.A.
        • Lauer S.
        • Schug B.S.
        Formulations of fentanyl for the management of pain.
        Drugs. 2010; 70: 57-72
        • Holdgate A.
        • Cao A.
        • Lo K.M.
        The implementation of intranasal fentanyl for children in a mixed adult and pediatric emergency department reduces time to analgesia administration.
        Society for Academic Emergency Medicine. 2010, January; 17: 1-4
        • Kavanagh T.
        • Watt-Watson J.
        • Stevens B.
        An examination of the factors enabling the successful implementation of evidence-based acute pain practices into pediatric nursing.
        Children's Health Care. 2007; 36: 303-321
        • Kennedy R.M.
        • Luhmann J.
        • Zempsky W.T.
        Clinical implications of unmanaged needle-insertion pain and distress in children.
        Pediatrics. 2008; 122: S130-S133
        • Krauss B.
        • Green S.M.
        Procedural sedation and analgesia in children.
        Lancet. 2006; 367: 766-780
        • Leykin Y.
        • Pellis T.
        • Ambrosio C.
        Highlights in postoperative pain treatment.
        Expert Review of Neurotherapeutics. 2007; 7: 533-545
        • Mace S.E.
        • Barata I.A.
        • Cravero J.P.
        • Dalsey W.C.
        • Godwin S.A.
        • Kennedy R.M.
        • Wears R.L.
        • et al.
        Clinical policy: Evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department.
        Annals of Emergency Medicine. 2004; 44: 342-377
        • MacLaren J.
        • Kain Z.N.
        Research to practice in pediatric pain: What are we missing?.
        Pediatrics. 2008; 122: 443-444
        • MacLean S.
        • Obispo J.
        • Young K.
        The gap between pediatric emergency department procedural pain management treatments available and actual practice.
        Pediatric Emergency Care. 2007; 23: 87-93
        • Magaret N.D.
        • Clark T.A.
        • Warden C.R.
        • Magnusson A.R.
        • Hedges J.R.
        Patient satisfaction in the emergency department—a survey of pediatric patients and their parents.
        Academic Emergency Medicine. 2002; 9: 1379-1388
        • Manjushree R.
        • Lahiri A.
        • Ghosh B.R.
        • Laha A.
        • Handa K.
        Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients.
        Canadian Journal of Anesthesia. 2002; 49: 190-193
        • Robertson J.
        • Shilkofski N.
        The Harriet Lane handbook.
        17th ed. Mosby, Philadelphia, PA2005
        • Rupp T.
        • Delaney K.A.
        Inadequate analgesia in emergency medicine.
        Annals of Emergency Medicine. 2004; 43: 494-503
        • Shelley K.
        • Paech M.J.
        The clinical application of intranasal opioids.
        Current Drug Delivery. 2008; 5: 55-58
      3. Starship Children's Health. (2007). Starship Children's Health clinical guideline. Retrieved from

      4. Sunshine Hospital. (2008). Intranasal fentanyl. Retrieved from

        • Voronov P.
        • Tobin M.J.
        • Billings K.
        • Cote C.J.
        • Ayer A.
        • Suresh S.
        Postoperative pain relief in infants undergoing myringotomy and tube placement: Comparison of a novel regional anesthetic block to intranasal fentanyl—a pilot analysis.
        Pediatric Anesthesia. 2008; 18: 1196-1201
        • Younge P.A.
        • Nicol M.F.
        • Kendall J.M.
        • Harrington A.P.
        A prospective randomized pilot comparison of intranasal fentanyl and intramuscular morphine for analgesia in children presenting to the emergency department with clinical fractures.
        Emergency Medicine. 1999; 11: 90-94


      Shawna Mudd, Pediatric Nurse Practitioner, The Johns Hopkins University, Baltimore, MD.