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Kinder- und Jugendmedizin 2004; 4(05): 168-176
DOI: 10.1055/s-0037-1617831
Schmerz
Schattauer GmbH

Fentanyl in der Schmerztherapie von Kindern jenseits des Neugeborenenalters

Fentanyl in the pain management of children
Stefan Friedrichsdorf
1   The Children’s Hospital at Westmead, University of Sydney, Pain & Palliative Care Service, Sydney/Australien (Leiter: Dr. John J. Collins, PhD)
2   Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Institut für Kinderschmerztherapie und Pädiatrische Palliativmedizin (Leiter: Dr. med. Boris Zernikow)
,
Boris Zernikow
2   Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Institut für Kinderschmerztherapie und Pädiatrische Palliativmedizin (Leiter: Dr. med. Boris Zernikow)
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Publication History

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Fentanyl wird in der Pädiatrie seit vielen Jahren zur Analgesie und Analgosedierung eingesetzt. Weit verbreitet ist der intravenöse Einsatz vor schmerzhaften Eingriffen und die Analgosedierung beatmeter Kinder auf der Intensivstation. Zunehmende Bedeutung gewinnt die patientenkontrollierte Analgesie (PCA) postoperativer, onkologischer und palliativer pädiatrischer Patienten. Erfolgreiche Anwendungen im Kindesalter umfassen darüber hinaus das Fentanylpflaster (Fentanyl-TSS) und den transmukösen Fentanyllutscher. Die Autoren geben eine Übersicht zu Metabolismus, Pharmakokinetik, Nebenwirkungen, Dosierungsvorschlägen sowie Anwendungsformen von topischem, oralem und intravenösem Fentanyl im Kindesalter gestützt auf randomisierte Studien der Jahre 1989-2003.

Summary

Fentanyl has been used in paediatrics for many years as an analgesic drug and for sedation analgesia. It is widely used intravenously prior to painful procedures and for sedation analgesia of ventilated children on the intensive care unit. Fentanyl has gained importance in patient controlled analgesia (PCA) of children with cancer, postoperatively and in paediatric palliative care. Applications, which have been used successfully in paediatrics, include the fentanyl patch (TSS fentanyl) and the transmucosal fentanyl lozenge. This article reviews metabolism, pharmacokinetics, adverse effects, dose ranges, and forms of topical, oral and intravenous applied fentanyl based on paediatric randomized controlled studies from 1989-2003.

Schlüsselwörter

Fentanyl - Analgesie - evidenzbasiert

Keywords

Fentanyl - analgesia - evidence based
 

  • Literatur

  • 1 Ashburn MA, Streisand JB. Oral transmucosal fentanyl – Help or hinderance?. Drug Safety 1994; 11 (05) 295-300.
    CrossrefGoogle Scholar
  • 2 Ashburn MA, Streisand J, Zhang J, Love G, Rowin M, Niu S, Kievit JK, Kroep JR, Mertens MJ. The iontophoresis of fentanyl citrate in humans. Anesthesiology 1995; 82 (05) 1164-53.
    Google Scholar
  • 3 Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preferance, efficacy and quality of life. J Pain Sympt Manage 1997; 13: 254-61.
    CrossrefGoogle Scholar
  • 4 American Academy of Pediatrics, Committe on Drugs. Alternative routes of drug administration – advantages and disadvantages. Pediatrics 1997; 100: 143-52.
    CrossrefGoogle Scholar
  • 5 Anderson AB, Colecci C, Baronoski R, DeWitt TG. Local anesthesia in pediatric patients: topical TAC versus lidocaine. Ann Emerg Med 1990; 19: 519-22.
    CrossrefGoogle Scholar
  • 6 Bartfield JM, Flint RD, McErlean M, Broderick J. Nebulized fentanyl for relief of abdominal pain. Acad Emerg Med 2003; 10 (03) 215-8.
    CrossrefGoogle Scholar
  • 7 Billmire DA, Neale HW, Gregory RO. Use of IV fentanyl in the outpatient treatment of pediatric facial trauma. J Trauma-Injury Infect Crit Care 1985; 25 (11) 1079-80.
    Google Scholar
  • 8 Borland ML, Jacobs I, Geelhoed G. Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Emerg Med (Fremantle) 2002; 14 (03) 275-80.
    CrossrefGoogle Scholar
  • 9 Cherny NJ, Chang V, Frager G, Ingham JM, Tiseo PJ, Popp B, Portenoy RK, Foley KM. Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration. Cancer 1995; 76: 1283-93.
    CrossrefGoogle Scholar
  • 10 Christensen ML, Wang WC, Harris S, Eades SK, Wilimas JA. Transdermal fentanyl administration in children and adolescents with sickle cell pain crisis. J Pediatr Hematol Oncol 1996; 18 (04) 372-6.
    CrossrefGoogle Scholar
  • 11 Collins C, Koren G, Crean P, Klein J, Roy WL, MacLeod SM. Fentanyl pharmacokinetics and hemodynamic effects in preterm infants during ligation of patent ductus arteriosus. Anesth Analg 1985; 64: 1078-80.
    Google Scholar
  • 12 Collins JJ, Dunkel IJ, Gupta SK, Inturrisi CE, Lapin J, Palmer LN, Weinstein SM, Portenoy RK. Transdermal fentanyl in children with cancer pain: feasibility, tolerability, and pharmacokinetic correlates. J Pediatr 1999; 134 (03) 319-23.
    CrossrefGoogle Scholar
  • 13 Concha M, González A, González J, Vergara R. Analgésie postopératoire pour la chirurgie ambulatoire chez l’ enfant: Comparaison de deux techniques. Ca Anesth 1994; 42: 339-42.
    Google Scholar
  • 14 Coyle N, Layman-Goldstein M. Pain Assessment and Management in Palliative Care. In: LaPorte Matzo M, Witt Sherman D. (eds). Palliative Care Nursing: Quality Care to the End of Life. Heidelberg: Springer; 2001: 362-486.
    Google Scholar
  • 15 Coyne PJ, Viswanathan R, Smith TJ. Nebulized fentanyl citrate improves patients’ perception of breathing, respiratory rate, and oxygen saturation in dyspnea. J Pain Symptom Manage 2002; 23 (02) 157-60.
    CrossrefGoogle Scholar
  • 16 Donner B, Zenz M, Strumpf M, Raber M. Long-term treatment of cancer pain with transdermal fentanyl. J Pain Symptom Manage 1998; 15 (03) 168-75.
    CrossrefGoogle Scholar
  • 17 Dsida RM, Wheeler M, Birmingham PK, Henthorn TK, Avram MJ, Enders-Klein CBA, Maddalozzo J, Coté CJ. Premedication of pediatric tonsillectomy patients with oral transmucosal fentanyl citrate. Anesth Analg 1998; 86 (01) 66-70.
    Google Scholar
  • 18 Epstein RH, Mendel HG, Witkowski TA, Waters R, Guarniari KM, Marr A, Lessin JB. The safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children. Anesth Analg 1996; 83 (06) 1200-5.
    CrossrefGoogle Scholar
  • 19 Feld LH, Champeau MW, van Steennis CA, Scott JC. Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo. Anesthesiology 1989; 71 (03) 374-7.
    CrossrefGoogle Scholar
  • 20 Food and Drug Administration (testimony before FDA subcommittee). Subcommittee of the Anesthetic & Life Support Drugs Advisory Committee on Pediatric Sedation. Washington, DC, USA: March 1-2 1994
    Google Scholar
  • 21 Friedrichsdorf S, Collins JJ. Unveröffentlichte Daten.
    Google Scholar
  • 22 Friesen RH, Carpenter E, Madigan CK, Lockhart CH. Oral transmucosal fentanyl citrate for preanaesthetic medication of paediatric cardiac surgery patients. Paed Anaesth 1995; 5: 29-33.
    Google Scholar
  • 23 Fujita K, Hidaka M, Takamura N, Yamasaki K, Iwakiri T, Okumura M, Kodama H, Yamaguchi M, Ikenoue T, Arimori K. Inhibitory effects of citrus fruits on cytochrome P450. Biol Pharm Bull 2003; 26 (09) 1371-3.
    CrossrefGoogle Scholar
  • 24 Galinkin JL, Fazi LM, Cuy RM, Chiavacci RM, Kurth CD, Shah UK, Jacobs IN, Watcha MF. Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology 2000; 93 (06) 1378-83.
    CrossrefGoogle Scholar
  • 25 Gauntlett IS, Fisher DM, Hertzka RE, Kuhls E, Spellman MJ, Rudolph C. Pharmacokinetics of fentanyl in neonatal humans and lambs: effects of age. Anesthesiology 1988; 669: 683-7.
    Google Scholar
  • 26 Gibson l, Cooke R. A test for the concentration of electrolytes in sweat in cystic fibrosis of the pancreas utilizing pilocarpine by iontophoresis. Pediatrics 1959; 23: 545-9.
    CrossrefPubMedGoogle Scholar
  • 27 Goldstein-Dresner MC, Davis PJ, Kretchman E, Siewers RD, Certo N, Cook DR. Doubleblind comparison of oral transmucosal fentanyl citrate with oral meperidine, diazepam, and atropine as preanesthetic medication in children with congenital heart disease. Anesthesiology 1991; 74 (01) 28-33.
    CrossrefGoogle Scholar
  • 28 Goodarzi M. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Paediatr Anesth 1999; 9: 419-22.
    CrossrefGoogle Scholar
  • 29 Graff KJ, Kennedy RM, Jaffe DM. Conscious sedation for pediatric orthopaedic emergencies. Ped Emerg Care 1996; 12 (01) 31-5.
    CrossrefGoogle Scholar
  • 30 Hickey R, Wells L. Subcutaneous fentanyl and midazolam: an alternative method of weaning after intravenous sedation in pediatric patients. Crit Care Med 1999; 27 (10) 2320-1.
    CrossrefGoogle Scholar
  • 31 Higgens MJ, Asbury AJ, Brodie MJ. Inhaled nebulised fentanyl for postoperative analgesia. Anesthesia 1991; 46: 973-6.
    CrossrefGoogle Scholar
  • 32 Ho PC, Saville DJ, Wanwimolruk S. Inhibition of human CYP3A4 activity by grapefruit flavonoids, furanocoumarins and related compounds. J Pharm Pharm Sci 2001; 4 (03) 217-27.
    Google Scholar
  • 33 Howell TK, Smith S, Rushman SC, Walker RWM, Radivan F. A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children. Anaesth 2002; 57 (08) 798-805.
    Google Scholar
  • 34 Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992; 76: 334-41.
    CrossrefGoogle Scholar
  • 35 Hunt A, Goldman A, Devine T, Phillips M. FEN-GBR-14 Study Group. Transdermal fentanyl for pain relief in a paediatric palliative care population. Palliat Med 2001; 15 (05) 405-12.
    CrossrefGoogle Scholar
  • 36 Irving H, Myles J, Thompson A, McDonnell A, Skinner R, Pearson A. The use of transdermal fentanyl in adolescent palliative patients – a single-centre experience. Abstract 4th Congress of the European Association of Palliative Care. Barcelona, Spain: December 6-9 1995
    Google Scholar
  • 37 Jacox A, Carr DB, Payne R, Berde CB, Breitbart W, Cain JM, Chapman CR, Cleeland CS, Berde CB. Management of cancer pain. Clinical Practice Guideline No. 9. AHCPR Publication No.94-0592.
    Google Scholar
  • 38 Kennedy RM, Porter FL, Miller JP, David M. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics 1998; 102 (04) 956-63.
    CrossrefGoogle Scholar
  • 39 Klein EJ, Diekema DS, Paris CA, Quan L, Cohen M, Seidel KD. A randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair. Pediatrics 2002; 109: 894-7.
    CrossrefGoogle Scholar
  • 40 Koren G, Goresky G, Crean P, Klein J, MacLeod SM. Pediatric fentanyl dosing based on pharmacokinetics during cardiac surgery. Anesth Analg 1984; 63: 577-82.
    Google Scholar
  • 41 Lee M, Kern SE, Kisicki JC, Egan TD. A pharmacokinetic study to compare two simultaneous 400 μg doses with a single 800 μg dose of oral transmucosal fentanyl citrate. J Pain Sympt Managem 2003; 26 (02) 743-7.
    Google Scholar
  • 42 Levron JC. Pharmacokinetique: de la Recherche a la Clinique. Ed. by Bres J, Panis G. Intern J Clin Pharm. John Libbey Eurotext 1992; Suppl. 199-203.
    Google Scholar
  • 43 Lichtor JL, Sevarino FB, Joshi GP, Busch MA, Nordbrock E, Ginsberg B. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg 1999; 89 (03) 732-8.
    Google Scholar
  • 44 Mannerkoski MK, Heiskala HJ, Santavuori PR, Pouttu JA. Transdermal fentanyl therapy for pain in children with infantile neuronal ceroid lipofuscinosis. Eur J Paediatr Neurol 2001; 5 Suppl A: 175-7.
    Google Scholar
  • 45 Manjushree R, Lahiri A, Ghosh BR, Arpita L, Handa K. Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients. Can J Anesth 2002; 49 (02) 190-3.
    CrossrefGoogle Scholar
  • 46 Marquardt KA, Tharratt RS. Inhalation abuse of fentanyl patch. J Toxicol Clin Toxicol 1994; 32 (01) 75-8.
    CrossrefGoogle Scholar
  • 47 Mather LE, Woodhouse A, Ward ME, Farr SJ, Rubsamen RA, Eltherington LG. Pulmonary administration of aerosolised fentanyl: pharmacokinetic analysis of systemic delivery. Br J Clin Pharmacol 1998; 46: 37-43.
    Google Scholar
  • 48 Monitto CL, Greenberg RS, Kost-Byerly S. The safety and efficacy of parent/nurse-controlled analgesia in patients less than six years of age. Anesth Analg 2000; 91: 573-9.
    CrossrefGoogle Scholar
  • 49 Nelson PS, Streisand JB, Mulder SM, Pace NL, Stanley TH. Comparison of oral transmucosal fentanyl citrate and an oral solution of meperidine, diazepam, and atropine for premedication in children. Anesthesiology 1989; 70 (04) 616-21.
    CrossrefGoogle Scholar
  • 50 Noyes M, Irving H. The use of transdermal fentanyl in pediatric oncology palliative care. Am J Hosp Palliat Care 2001; 18 (06) 411-6.
    CrossrefGoogle Scholar
  • 51 Patt RB, Lustik S, Litman RS. The use of transdermal fentanyl in a six-year-old patient with neuroblastoma and diffuse abdominal pain. J Pain Symptom Manage 1993; 8 (05) 317-9.
    CrossrefGoogle Scholar
  • 52 Paut O, Camboulives J, Viard L, Lemoing JP, Levron JC. Pharmacokinetics of transdermal fentanyl in the peri-operative period in young children. Anaesthesia 2000; 55 (12) 1202-7.
    CrossrefGoogle Scholar
  • 53 Peng PWH, Sandler AN. A rewiev of the use of fentanyl anagesia in the management of acute pain in adults. Anesthesiology 1999; 90: 576-99.
    CrossrefGoogle Scholar
  • 54 Pohlgeers AP, Friedland LR, Keegan-Jones L. Combination fentanyl and diazepam for pediatric conscious sedation. Acad Emerg Med 1995; 2 (10) 879-83.
    CrossrefGoogle Scholar
  • 55 Portenoy RK, Payne R, Coluzzi P, Raschko JW, Lyss A, Busch MA, Frigerio V, Ingham J, Loseth DB, Nordbrock E, Rhiner M. Pain 1999; 79: 303-12.
    Crossref
  • 56 Robert R, Brack A, Blakeney P, Villarreal C, Rosenberg L, Thomas C, Meyer 3rd WJ. A double-blind study of the analgesic efficacy of oral transmucosal fentanyl citrate and oral morphine in pediatric patients undergoing burn dressing change and tubbing. J Burn Care Rehab 2003; 24 (06) 351-5.
    CrossrefGoogle Scholar
  • 57 Schlechter NL, Weisman SJ, Rosenblum M, Bernstein B, Conard PL. The use of oral transmucosal fentanyl citrate for painful procedures in children. Pediatrics 1995; 95 (03) 335-9.
    Google Scholar
  • 58 Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2: 175-84.
    CrossrefGoogle Scholar
  • 59 Selbst SM, Zempsky WT. Sedation and analgesia in the emergency department. In: Schechter NL, Berde CB, Yaster M. (ed). Pain in infants, children, and adolescents. 2nd ed.. Philadelphia: lippincott Williams & Wilkins; 2003: 651-68.
    Google Scholar
  • 60 Sharar SR, Garrougher MN, Selzer K, O’Donnel F, Vavilala MS, Lee LD. A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabil 2000; 23: 27-31.
    Google Scholar
  • 61 Sharar SR, Bratton SL, Garrougher MN, Edwards WT, Summer G, Levy FH, Cortiella J. A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 1998; 19: 516-21.
    CrossrefGoogle Scholar
  • 62 Streisand JB, Busch MA, Egan TD, Smith BG, Gay M, Pace N. Dose proportionality and pharmacokinetics of oral transmucosal fentanyl citrate. Anesth 1998; 88 (02) 305-9.
    CrossrefGoogle Scholar
  • 63 Streisand JB, Varvel JR, Stanski DR, Le Maire L, Ashburn MA, Hague BI, Tarver SD, Stanley TH. Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 1991; 75 (02) 223-9.
    CrossrefGoogle Scholar
  • 64 Tamura M, Nakamura K, Kitamura R, Kitagawa S, Mori N, Ueda Y. Oral premedication with fentanyl may be a safe and effective alternative to oral midazolam. Europ J Anaesth 2003; 20 (06) 482-6.
    Google Scholar
  • 65 Tobias JD. Transdermal Fentanyl: applications and indications in the pediatric patient. AJPM 1992; 2: 30-3.
    Google Scholar
  • 66 Twycross R, Wilcock A, Charlesworth S, Dickman A. Analgesics. In: Twycross R, Wilcock A, Charlesworth S, Dickman A. Palliative Care Formulary. 2nd ed.. Oxford: Radcliff Medical Press; 2003: 129-202.
    Google Scholar
  • 67 Twycross R, Wilcock A, Charlesworth S, Dickman A. Appendix 9: Nebulised drugs. In: Twycross R, Wilcock A, Charlesworth S, Dickman A. Palliative Care Formulary. 2nd ed.. Oxford: Radcliff Medical Press; 2003: 351-4.
    Google Scholar
  • 68 Warner MA, Hosking MP, Gray JR, Squillace DL, Yunginger JW, Orszulak TA. Narcotic induced histamine release: a comparison of morphine, oxymorphone, and fentanyl infusion. J Cardiothorac Vasc Anesth 1991; 5: 481-4.
    CrossrefGoogle Scholar
  • 69 Wheeler M, Birmingham PK, Dsida RM, Wang Z, Coté CJ, Avram MJ. Uptake pharmacokinetics of the Fentanyl Oralet® in children scheduled for central venous access removal: implications for the timing of initiating painful procedures. Paed Anaesth 2002; 12: 594-9.
    Google Scholar
  • 70 Yaster M, Kost-Byerly S, Maxwell LG. Opioid agonists and antagonists. In: Schechter NL, Berde CB, Yaster M. (ed). Pain in infants, children, and adolescents. 2nd ed.. Philadelphia: Lippincott Williams & Wilkins; 2003: 181-224.
    Google Scholar
  • 71 Zempsky WT, Anand KS, Sullivan KM, Fraser D. Double-blind placebo-controlled study of lidocaine iontophoresis for intravenous line placement in children. Pediatr Emerg Care 1996; 12: 325.
    Google Scholar