• Intranasal fentanyl is a highly effective opioid for severe pain and should be administered in a timely manner.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Intranasal fentanyl is a highly effective opioid for the treatment of severe pain. Fentanyl is absorbed through the vascular nasal mucosa and avoids ‘first pass metabolism’ by the liver.

• Therapeutic levels are reached within 2 minutes.

• The quoted analgesic effect can last between 30-60 minutes.

Intranasal administration of fentanyl IV ampoules is an off-label use but is commonly used in this form across the world.

• Acute severe pain in a child.

• Examples include (but are not limited to) a clinically fractured limb, burns, fingertip injuries or lacerations requiring suturing.

• Use 100 mcg/2 mL strength fentanyl solution for intravenous use

• Initial dose = 1.5 mcg/kg dose - maximum 75 micrograms

• A second dose may be administered 10 minutes after the first to provide adequate analgesia = 1.5 mcg/kg, maximum 75 micrograms.

• If further doses are required a formal senior medical review (ST4+) should occur.

• Observe closely for adverse effects and over sedation.

The following describes best/ideal practice. It is acknowledged this may not always be possible in a distressed or young child:

1. Child’s head to be slightly tilted back with normal breathing.

2. Draw air into syringe and flick syringe to cause air to lie between liquid drug & syringe plunger. This will ensure as drug is pushed into the nose it is followed by air to clear the syringe tip.

3. If dose >1ml, ideally administer half dose per nostril (with other nostril occluded) to prevent loss of solution with child encouraged to ‘sniff’ during administration.

Care should be paid to how far the syringe tip is placed in the nostril to avoid damaging the nasal septum.

Two nurse preparation and checks are to be employed.

• Bad taste

• Vomiting (rare)

• Serious systemic side effects are uncommon, if given in correct dose, but includes hypotension and respiratory depression.

• Symptoms of URTI and nasal congestion might cause unreliable delivery of drug

• Epistaxis

• Prior dosing with opioids

• Known fentanyl hypersensitivity

• GCS <15

• Bilateral occluded nasal passages

• Epistaxis

– discuss with Consultant in charge.

• Age< 1 year (limited data on safety or efficacy in this age group)

• Head injury

• Hypovolaemia