Intranasal analgesia as an alternative to intravenous therapy for acute pain in adult emergency department patients: a systematic review.
Christèle Asmar, Raphaël Asmar, Ryan Hindy et al.
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In 30 seconds
This descriptive systematic review compared intranasal with intravenous analgesics for acute pain in adults presenting to emergency departments. It included randomized and observational studies identified through December 2025. Across 18 studies involving 1950 patients, intravenous treatment reduced pain more quickly at early timepoints (≤5-10 min), while intranasal analgesics provided clinically meaningful relief within 15-30 min and similar pain control by 30-60 min. Rescue analgesia and adverse event rates were comparable between routes. The authors conclude that intranasal analgesia is an effective and safe option for selected patients, especially when intravenous access is delayed or unnecessary.
Key findings
- Intravenous analgesics produced faster pain reduction at early timepoints (≤5-10 min).
- Intranasal analgesics achieved clinically meaningful pain relief within 15-30 min, with similar pain control to intravenous therapy by 30-60 min.
- Rescue analgesia and adverse event rates were comparable between intranasal and intravenous routes.
Why it matters
The review suggests that avoiding intravenous access need not preclude effective acute pain relief for selected emergency department patients. Intranasal delivery may be useful when access is delayed or unnecessary, although intravenous analgesia appears to act faster early on. The findings help frame route selection around the need for rapid initial relief and the feasibility of intravenous access.
What to keep in mind
The review included both randomized and observational studies and was descriptive; the abstract does not report a pooled effect estimate.