Prehospital Opioid Adverse Signs Were Uncommon in Children, but Pain Often Persisted

Researchers reviewed records for children aged 0–14 years who received prehospital opioids in the Region of Southern Denmark between 2017 and 2022. The retrospective register-based study assessed clinical signs compatible with opioid adverse effects, diagnoses, antidote use, vasopressor administration and analgesia given in hospital. Fentanyl, alone or with other analgesics, was used in 99.7% of cases; 97.0% of children received opioids within recommended dosage ranges.

At least one sign potentially compatible with opioid adverse effects was recorded in 15.1% of children (231/1,531). In 9.2% (141 children), the study found no other explanation for the signs. Nausea occurred in 5.6% and drowsiness in 2.5%. Bradycardia and respiratory depression were each recorded in 0.7%; no opioid antidotes were administered at hospital. Pain was documented at arrival in 63.6% of children, and 51% received additional in-hospital analgesia.

The authors note that persistent pain may reflect waning analgesia or insufficient pain management, but the findings cannot distinguish these explanations. Retrospective records may miss transient prehospital events and do not provide standardised pain trajectories. The results therefore do not establish opioid safety or prove prehospital undertreatment; prospective studies are needed to clarify timing, severity and causality.