ACUTE PAIN IN CHILDREN

YES CHILDREN ARE AFRAID OF NEEDLES AND INJECTIONS! A CHILD CRYING OF PAIN DUE TO INJURY, FRACTURE ,SICKLE CELL CRISIS OR DUE TO EVEN  DECAYED TOOTH, IS A CONCERN FOR THE MOTHER AS WELL AS FOR THE ATTENDING PHYSICIAN. IT IS HIGHLY IMPOSSIBLE AND CRUEL TO RESTRAIN A CRYING CHILD FOR INTRAVENOUS ACCESS, IN ORDER TO ADMINISTER ANALGESICS ESPECIALLY IN A&E AND IN WARDS. ALSO IV ANALGESICS LIKE MORPHINE  CAN CAUSE  IMMEDIATE SIDE EFFECTS DUE TO RAPID SYSTEMIC ABSORPTION. THE ANXIETY, APPREHENSION AND TENSION OF THE MOTHER ALSO TO BE CONSIDERED WHEN IV CANNULATION IS ATTEMPTED. ALL THESE CAN BE SURMOUNTED WITH THE INTRODUCTION OF DIAMORPHINE, WHICH IS FOUND TO BE EFFECTIVE WHEN ADMINISTERED INTRANASALLY, WHICH IS SLOWLY ABSORBED INTO THE SYTEMIC CIRCULATION THEREBY PRODUCING LESS SIDE EFFECTS, BUT PROVIDING EFFECTIVE PAIN RELIEF.

DIAMORPHINE IS A SEMISYNTHETIC DERIVATIVE OF MORPHINE AND CAN BE CONSIDERED AS A 'PRO-DRUG',EXERTING ITS EFFECTS BY ACTIVE METABOLITES.THE HALF LIFE IS 3-5 MINUTES AND IS HYDROLYSED AND DE ACETYLATED TO 6 MONO ACETYL MORPHINE AND THEN TO MORPHINE. MORPHINE IS THEN CONJUGATED AND EXCRETED.THE PHARMACOLOGICAL ACTION IS MAINLY DUE TO MORPHINE.

IT HAS BEEN SHOWN THAT DIAMORPHINE GIVEN INTRANASALLY 0.1 MG/KG ACHIEVED ADEQUATE PLASMA CONCENTRATIONS OF MORPHINE, COMPARABLE TO THE SAME DOSE GIVEN BY IV ROUTE. ALSO INTRANASAL DIAMORPHINE ADMINISTERED AS NASAL DROPS PRODUCED SIGNIFICANTLY ATTENUATED AND DELAYED PEAK PLASMA LEVELS OF MORPHINE COMPARED TO IV ROUTE, AND IS EFFECTIVE IN SICKLERS WHERE IV CANNULATION ITSELF IS DIFFICULT.

REF:S KIDD, S BRENNAN, R STEPHEN, R MINNS, T BEATTIE, COMPARISON OF MORPHINE CONCENTRATION TIME PROFILES FOLLOWING IV AND IN DIAMORPHINE, ARCHIVES OF DISEASE IN CHILDHOOD, DEC 2009 VOL94, ISSUE 12, THANX TO GOOGLE  IMAGE