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Severe pain – IN fentanyl — RACP Paediatrics MCQ

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HardEmergencySevere pain – IN fentanylRACP Paediatrics

A 7-year-old with a displaced forearm fracture has pain 9/10. He is alert, weighs 28 kg, has patent nasal passages and has received no opioid; IV access is not yet available. Which immediate opioid prescription is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intranasal fentanyl 1.5 micrograms/kg, with baseline sedation and respiratory observations

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

E is correct. For a child older than 12 months with moderate-to-severe pain and no IV access, RCH recommends intranasal fentanyl 1.5 micrograms/kg (maximum 100 micrograms), with baseline pain, sedation and respiratory observations. A is a major overdose and repeats too soon. B has a slower onset and the dose/route comparison is misleading. C is painful and offers no advantage over the effective non-invasive route. D uses the correct dose but falsely removes monitoring: sedation, respiratory depression and hypotension are uncommon but recognised. Pain is reassessed after five to ten minutes; a second 0.75–1.5 micrograms/kg dose may be considered, followed by an ongoing analgesia plan.

Reference: Royal Children’s Hospital Melbourne: Intranasal fentanyl: https://www.rch.org.au/clinicalguide/guideline_index/intranasal_fentanyl/