Intranasal Diamorphine Usage in Paediatric Accident and Emergency

Intranasal diamorphine is a rapid, effective, analgesia, with few side effects, giving it multiple advantages over other forms of analgesia. It is also importantly a needle free alternative, acceptable to children, parents and medical staff. Due to these advantages, it is thought to be increasingly used in Paediatric A&E, and possibly the most popular analgesia for severe acute pain, despite being unlicensed. However, there is little quantified data on the extent of its usage. In order to clarify this, we surveyed all 214 NHS A&E departments in England in Wales with the scenario of an uncomplicated long bone fracture. There were 116 responses (75% return rate), showing that 60% of departments were using intranasal opioid (90% diamorphine) as 1st line and 70% as 1st or 2nd line analgesia for long bone fracture. When compared to any other drugs used, intranasal diamorphine was nearly four times more likely to be used as the 1st line analgesia. Despite being unlicensed, intranasal diamorphine is widely accepted and the most commonly used analgesia in Paediatric A&E for acute pain in long bone fracture. This article also reviews the literature on intranasal diamorphine with an emphasis on Paediatric usage.