Intranasal diamorphine (IN diamorphine) in children
Intranasal diamorphine (atomised diamorphine) is a rapid‑onset opioid option for children with severe acute pain when intravenous access is not available or oral administration is refused or impractical.
It is used in UK emergency practice for clinically suspected limb fractures, large or painful burns, significant fingertip injuries and similar severe painful presentations (RCEM; local trust guidelines). Use must follow local controlled‑drug procedures and pharmacy dilution tables.
Key pharmacology and rationale
Intranasal atomised delivery gives rapid systemic absorption across the nasal mucosa, providing analgesia within minutes and bridging to definitive analgesia (IV opioid, regional block or surgical management). A mucosal atomiser device (MAD) produces a fine spray that improves mucosal coverage and absorption compared with simple instillation.
Indications (typical ED practice)
Consider IN diamorphine for children with severe acute pain when an opioid is appropriate and other routes are unsuitable or delayed. Common examples include:
- Clinically suspected limb fractures with significant pain
- Large or painful burns
- Significant fingertip injuries
- Children who refuse or cannot tolerate oral morphine solution
Also consider where IV access is not yet established and rapid analgesia is required (NICE NG41; RCEM).
Contraindications and exclusions (common UK practice)
Follow local policy. Typical exclusions include: