IN Ketamine vs IN Fentanyl
The Article: The PITCHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries. Annals of EM. March 2015.
The Idea: To determine if IN ketamine is equally as effective as IN fentanyl in controlling pain in children presenting to the ED with moderate to severe pain from an isolated limb injury.
The Study: Double-blind, randomized, controlled trial. 80 children enrolled were randomly selected to receive IN fentanyl 1.5 microgram/kg or IN ketamine 1 mg/kg, plus PO ibuprofen at 10mg/kg in both groups. Pt’s pain levels were reassesed at 15, 30 and 60 minutes.
The Findings: IN ketamine and IN fentanyl were associated with similar pain reduction in children with moderate to severe pain from isolated limb injury. IN ketamine was associated with more mild adverse events (mostly dizziness and drowsiness).
The Takeaway: IN ketamine seems to be an effective alternative to IN fentanyl in children with moderate to severe pain, particularly if opiates are contraindicated.