Transdermal fentanyl administration in children and adolescents with sickle cell pain crisis

• Published in: Journal of pediatric hematology/oncology Vol. 18; no. 4; pp. 372 - 376
• Main Authors: CHRISTENSEN, M. L, WANG, W. C, HARRIS, S, EADES, S. K, WILIMAS, J. A
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-11-1996
• Subjects: Administration, Cutaneous; Adolescent; Analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - blood; Anemia, Sickle Cell - drug therapy; Biological and medical sciences; Child; Dose-Response Relationship, Drug; Female; Fentanyl - administration & dosage; Fentanyl - blood; Humans; Male; Medical sciences; Neuropharmacology; Palliative Care; Pharmacology. Drug treatments; Human; Delivery system; Hemoglobinopathy; Sickle cell anemia; Controlled release form; Fentanyl; Opiates; Hemopathy; Narcotic analgesic; Genetic disease; Crisis; Percutaneous route; Assay; Analgesia; Hemolytic anemia; Pain; Treatment; Adolescent; Child
• ISSN: 1077-4114; 1536-3678
• DOI: 10.1097/00043426-199611000-00007

The purpose of this study was to determine the dose-concentration relationship and clinical effect of transdermal fentanyl (TF) in patients with sickle cell pain crisis (SCPC).
Ten patients aged 9-16 years were studied. Patients initially received a TF dose of 25 (n = 7) or 50 (n = 3) micrograms/h if morphine use was > 2.5 mg/h. Supplemental morphine usage via patient-controlled analgesia (PCA), sedation status, pain status, respiratory rate, pulse rate, oxygen saturation, and blood pressure were monitored.
The average TF dose was 0.77 +/- 0.37 micrograms/kg/h on day 1 and 1.17 +/- 0.46 micrograms/kg/h on day 2. Fentanyl concentrations measured at 24 and 48 h were 0.60 +/- 0.31 and 1.18 +/- 0.44 ng/ml, respectively. A significant relationship existed between TF dose and fentanyl concentration (r2 = 0.56, p < 0.01). There was no difference in any of the clinical monitoring parameters between day 1 and day 2. However, 7 of 10 patients reported subjective improvement in pain control over that achieved with PCA alone. No adverse effects were noted.
Improved understanding of the dose-effect relationship for TF in children and adolescents is necessary before adequate pain control can be achieved with this delivery system.