{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:41:21Z","timestamp":1792402881342,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":291,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Research and Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pain 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and network meta\u2010analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0\u201318\u2009years 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Fifteen 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\u2009min, 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\u2010dose 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/prm\/1894053","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:02:07Z","timestamp":1792400527000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Intranasal Analgesia for Acute Pain in Pediatric Emergency Departments: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7278-2289","authenticated-orcid":false,"given":"Mohammed","family":"Alsabri","sequence":"first","affiliation":[{"name":"Emergency Department Althawra Modern General Hospital  Sana\u2019a Yemen"},{"name":"Pediatric Emergency Department Department of Pediatrics St. Christopher\u2019s Hospital for Children  Philadelphia Pennsylvania USA  stchristophershospital.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2159-0234","authenticated-orcid":false,"given":"Yahya A.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Al-Azhar University  Gaza State of Palestine  azhar.edu.eg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4273-0827","authenticated-orcid":false,"given":"Shree","family":"Rath","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences (AIIMS)  Bhubaneswar India  aiims.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2087-3297","authenticated-orcid":false,"given":"Eslam","family":"Abady","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Tanta University  Tanta Egypt  tanta.edu.eg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8678-6284","authenticated-orcid":false,"given":"Mohamed Ashraf","family":"Shehab","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Menoufia Egypt  menofia.edu.eg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4578-0824","authenticated-orcid":false,"given":"Raseel","family":"Sleem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University  Menoufia Egypt  menofia.edu.eg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis L.","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Assistant Professor of Pediatrics Drexel University College of Medicine  Philadelphia Pennsylvania USA  drexel.edu"},{"name":"Program Director Pediatric Emergency Medicine Fellowship St. Christopher\u2019s Hospital for Children  Philadelphia Pennsylvania USA  stchristophershospital.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Hamzah","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology Advocate Children\u2019s Hospital  Oak Lawn Illinois USA  advocatechildrenshospital.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7666-9063","authenticated-orcid":false,"given":"Michael","family":"Gillman","sequence":"additional","affiliation":[{"name":"Department 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  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