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Editor,—We would like to describe a patient who benefited from intranasal diamorphine administration. This route has become an acceptable way of providing analgesia for children in severe pain. We believe it is also an acceptable and potentially important route for adults. It is rapidly absorbed from the venous plexi of the nasal mucosa and provides less variable pain relief than rectal or oral routes. Its aqueous solubility allows the use of small volumes.1
We recently used intranasal diamorphine as pain relief in a 57 year old woman. This woman suffered with chronic renal failure, and underwent frequent haemodialysis. She had fallen onto her right hand. Her right elbow was tender, swollen and deformed. She was supporting this elbow with her uninjured forearm. This combined with an arteriovenous shunt in the left arm made venous access difficult. She was crying out in pain and severely distressed. To allow immobilisation and investigation she was given intranasal diamorphine, at a dose of 0.1 mg/kg.1 This gave immediate pain relief. Radiographs revealed a displaced four part supracondylar fracture of the right humerus with an intra-articular component.
Although the oral or intravenous routes remain the most favoured for analgesia, it is our experience that they are not always available. The oral route may be inaccessible, for example, in a hard collar or may take longer to work because of delayed gastric emptying. Intravenous and intramuscular routes are alternatives but a patient may refuse such analgesia because of a dislike of injections. The intramuscular route also has delayed action.2 The rectal route can be embarrassing and uncomfortable. Rapid analgesia may be necessary and the intranasal route provides this when intravenous access cannot be secured or is not strictly necessary.
We have used intranasal diamorphine on several occasions. During its use we monitor vital signs. Pain scores or direct questioning measures its efficacy.3 We believe that a prospective study of its use would permit identification of potential side effects or complications. It is our experience that these do not occur. Our experience is insufficient to identify whether nausea and vomiting would be a significant problem.
We feel it is an important adjunct in certain clinical situations and a valuable addition to pain management.
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