Needle-free nasal spray delivers rapid pain relief for children in emergency departments

A simple nasal spray combining two well-established pain medications could transform the way emergency departments manage one of their most common and most neglected challenges: the pain of an injured child. New research presented at the European Emergency Medicine Congress in Paris suggests that a needle-free combination of sufentanil and ketamine, delivered through a weight-adjusted number of puffs into the nose, brings rapid and meaningful relief to children arriving at hospital with fractures, dislocations, burns and soft tissue injuries. For a field in which clinicians have long complained that paediatric pain is under-recognised and under-treated, the findings offer something rare: an effective option that is quick to give, easy to dose and well tolerated by patients as young as one year old.

The study was led by Professor Shammi Ramlakhan, an emergency medicine consultant working at Sheffield Children’s Hospital, the University of Sheffield and Sheffield Hallam University in the United Kingdom. He presented the results at the congress on Sunday, describing a problem that emergency clinicians across Europe will recognise immediately. According to Ramlakhan, nearly a third of children with moderate to severe pain do not receive adequate pain relief within the 15 to 20 minutes recommended in international guidance. That gap matters, because unrelieved pain in childhood is not merely a momentary distress; it can heighten fear of medical care, complicate examinations and procedures, and leave lasting psychological imprints on young patients and their families.

The trial enrolled 152 children aged between one and 17 years who presented with moderate to severe pain at one of seven hospital emergency departments in the United Kingdom and Spain between May 2024 and May 2025. The majority of participants had limb injuries, including fractures and dislocations, while others had burns or injuries to soft tissue. These are precisely the presentations that fill paediatric emergency departments every day, and they are the cases in which timely analgesia can make the difference between a manageable visit and a traumatic ordeal.

Every child in the study received the same combination of two analgesic medications: sufentanil, a potent opioid, and ketamine, a dissociative anaesthetic with strong analgesic properties. The drugs were administered together via a nasal spray, with the dose adjusted to each child’s body weight simply by varying the number of puffs. This dosing system is one of the study’s most significant technical features. Intravenous cannulation, the traditional route for strong analgesia in emergency care, is itself painful, frightening and technically difficult in small, distressed children with injured limbs. A spray that eliminates the needle removes a major barrier to early treatment and allows analgesia to begin within minutes of arrival.

The researchers assessed each child’s pain using standard validated instruments at two time points: 15 minutes and 30 minutes after administration. They also monitored for adverse effects throughout. The results were striking. After 15 minutes, more than half of the children, 54 percent, were already in less pain. By 30 minutes, the vast majority, 88 percent, reported reduced pain, and in 86.2 percent of children the pain score had fallen by around half. For a single, needle-free administration delivered in a busy emergency department, that speed and magnitude of effect is notable, particularly given that the treatment window studied matches the timelines set out in international paediatric pain guidance.

Safety findings were equally encouraging. Side effects were mild and consisted of nausea or vomiting, dizziness and nasal itching. No major adverse events were reported. Ramlakhan noted that children tolerated the spray well and emphasised the practical significance of the result: the treatment gives doctors a simple and effective option in a setting where, in his words, very few options currently exist. The absence of significant drowsiness is also clinically relevant, because heavy sedation can obscure the neurological assessment of a child and complicate decisions about imaging and further management.

The nasal spray was being tested under the European Medicines Agency’s paediatric-use marketing authorisation, or PUMA, scheme. This regulatory pathway exists specifically to encourage manufacturers to develop and adapt medicines for children, a population that has historically been underserved by the pharmaceutical industry because paediatric formulations are commercially less attractive and clinically more demanding to validate. Many drugs used in paediatric emergency care are administered off-label, with dosing extrapolated from adult evidence. A product developed and authorised specifically for children, with a dosing system designed around their weight and their tolerance, addresses a structural weakness in paediatric medicine. The researchers say the treatment should be available for use in Europe in the near future.

Independent commentary on the work underlined how significant the gap is that this spray could fill. Dr Maša Sorić, a member of the European Society for Emergency Medicine abstract selection committee and head of the emergency department at University Hospital Merkur in Zagreb, Croatia, who was not involved in the research, pointed out that millions of children are seen in European emergency departments every year, many suffering painful injuries, and that being in hospital can itself be frightening for children and their families. In her assessment, the study evaluated a nasal spray containing two existing types of pain relief with a very simple dosing system, and the results suggest it reduces pain quickly and effectively without the need for an injection, without causing excessive drowsiness and with only mild side effects.

Sorić also framed the broader clinical context: doctors want to give patients effective treatments, including treatment for pain, but the analgesic options currently available for children are limited. Her remarks reflect a long-standing tension in emergency medicine. Strong opioids and anaesthetics are the tools that work fastest, yet in children they have traditionally required intravenous access, careful titration and monitoring resources that many departments struggle to mobilise quickly. Weaker oral medications, meanwhile, often act too slowly or too weakly for severe pain. A nasal spray that combines a fast-acting opioid with ketamine, dosed by puff count and requiring no cannula, sits in the gap between those extremes and could realistically be administered by nursing staff within minutes of triage.

The study was experimental in design and involved people as its research subject, and its findings were presented at a congress rather than yet published in a peer-reviewed journal, so wider confirmation will be watched with interest. Even so, the combination of a large multi-centre cohort across two countries, validated pain assessments, a dosing method simple enough for routine practice and a clean safety profile makes a persuasive case. If the treatment reaches European emergency departments as its developers expect, the change could be felt immediately by the patients least equipped to articulate their suffering. A child with a broken arm who receives effective analgesia within fifteen minutes of arrival, without a needle, experiences a fundamentally different hospital visit from one who waits in pain. For clinicians who have spent years working around the absence of good paediatric pain options, a spray bottle may prove to be one of the most consequential tools the specialty has gained.

Subject of Research: Needle-free nasal spray analgesia for children with moderate to severe pain in emergency departments

Article Title: Nasal spray brings pain relief for children treated in the emergency department

Article References: Nasal spray brings pain relief for children treated in the emergency department. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: nasal spray, pain relief, children, emergency department, sufentanil, ketamine, paediatric medicine, analgesia, European Emergency Medicine Congress, needle-free, PUMA, clinical trial