The Case

An 8-year-old boy presents to the emergency department with a painful wrist injury after falling at the playground. His parents gave him an appropriate dose of ibuprofen before arriving at the emergency department. His pain is a 7/10, and the triage nurse asks you for some additional medication for his pain while he is waiting for his X-ray.

Background

Children represent a group of patients who aren’t likely to receive adequate analgesia.1,2 This phenomenon is known as oligoanalgesia, or poor pain management through the underuse of analgesics. Despite three decades of research in this area, recent evidence confirms that ED pain management in children is still suboptimal.

A retrospective cohort study of children presenting to the emergency department with an isolated long-bone fracture showed almost one-third received inadequate medication, and 59 percent received no pain medications during the critical first hour of assessment.3 Other studies have demonstrated that only 35 percent of children presenting to a pediatric emergency department with fractures or severe sprains receive any analgesics.4,5 Two potential options for providing faster-acting, effective, and easy-to-administer pain medications to children are intranasal (IN) fentanyl and ketamine.

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