Evidence map›Paper›PMID 42895051›Full record

SynthesisPain research & management2026

Use of Intranasal Analgesia for Acute Pain in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Mohammed Alsabri, Yahya A Mahmoud, Shree Rath, Eslam Abady, Mohamed Ashraf Shehab, Raseel Sleem, Luis L Gamboa, Mohammed Hamzah, Michael Gillman

Abstract readSystematic ReviewMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Pain research & management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mohammed AlsabriEmergency Department, Althawra Modern General Hospital, Sana'a, Yemen.ORCID https://orcid.org/0000-0002-7278-2289
Yahya A MahmoudFaculty of Medicine, Al-Azhar University, Gaza, State of Palestine, azhar.edu.eg.ORCID https://orcid.org/0009-0009-2159-0234
Shree RathAll India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, aiims.edu.ORCID https://orcid.org/0009-0000-4273-0827
Eslam AbadyFaculty of Medicine, Tanta University, Tanta, Egypt, tanta.edu.eg.ORCID https://orcid.org/0009-0007-2087-3297
Mohamed Ashraf ShehabFaculty of Medicine, Menoufia University, Menoufia, Egypt, menofia.edu.eg.ORCID https://orcid.org/0009-0007-8678-6284
Raseel SleemFaculty of Medicine, Menoufia University, Menoufia, Egypt, menofia.edu.eg.ORCID https://orcid.org/0009-0002-4578-0824
Luis L GamboaAssistant Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA, drexel.edu.
Mohammed HamzahDepartment of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA, advocatechildrenshospital.com.
Michael GillmanDepartment of Pediatric Emergency Medicine, Assistant Professor of Emergency Medicine, Clerkship Director, Cooper Longitudinal Integrated Clerkship, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey, USA, cooperhealth.org.ORCID https://orcid.org/0009-0005-7666-9063

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPain is one of the most common reasons for presentation to pediatric emergency departments, yet timely and effective analgesia remains inconsistently delivered. Intranasal (IN) analgesics offer a noninvasive alternative to injectable routes, but their comparative effectiveness, safety, and acceptability across agents and routes remain incompletely defined.

methodsWe conducted a systematic review and network meta-analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0-18 years presenting to emergency or prehospital settings. Eligible trials compared IN agents with alternative IN formulations, intravenous, intramuscular, oral analgesics, or placebo. Pain reduction measured using validated pediatric pain scales at predefined timepoints was the primary outcome. Secondary outcomes included need for rescue analgesia, adverse events, acceptability, and emergency department length of stay.

findingsFifteen randomized controlled trials involving 1388 pediatric patients were included. Across all evaluated timepoints, including the primary outcome and assessments at 10, 15, 20, 30, and 60 min, no IN or intravenous analgesic demonstrated statistically superior pain reduction compared with IN fentanyl. Requirements for rescue analgesia were similarly comparable across treatments. IN ketamine was associated with a significantly higher risk of adverse events compared with standard-dose IN fentanyl, although events were predominantly mild and transient. Acceptability among patients, caregivers, and providers was high across IN agents, and available data indicated no clinically meaningful differences in emergency department length of stay.

Indexed as

Acute PainAnalgesiaAnalgesicsEmergency Service, HospitalPain ManagementAdministration, IntranasalAdolescentChildChild, PreschoolHumansInfantPain MeasurementRandomized Controlled Trials as TopicAnalgesicsacute painemergency departmentfentanylintranasal analgesiaketaminemeta-analysispain managementpediatric emergency medicinerandomized controlled trialssystematic review

Identifiers

PMID42895051
PMCPMC13678576

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.