Frey TM, et al. - In children (aged 8 to 17 years) presenting to the Emergency Department with moderate to severe pain due to traumatic limb injuries between March 2016 and February 2017, researchers determined whether intranasal ketamine is noninferior to intranasal fentanyl for pain reduction. The results obtained from the Pain Reduction With Intranasal Medications for Extremity Injuries (PRIME) trial indicate that ketamine provides effective analgesia that is noninferior to fentanyl, although participants who received ketamine experienced an increase in minor and transient adverse events. For pain associated with acute extremity injuries, intranasal ketamine might be an appropriate alternative to intranasal fentanyl. Ketamine should be taken into account for pediatric pain management in emergency situations, particularly when opioids are contraindicated or related to increased risk, such as before procedural sedation.