Frey TM, et al. - Researchers determined whether intranasal ketamine is noninferior to intranasal fentanyl for pain reduction 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. The results obtained from the Pain Reduction With Intranasal Medications for Extremity Injuries (PRIME) trial show 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 related to acute extremity injuries, intranasal ketamine might be an appropriate alternative to intranasal fentanyl. For pediatric pain management in an emergency setting, ketamine should be considered, in particular, if opioids are associated with increased risk.