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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
M L
ML
Christensen
W C
WC
Wang
S
S
Harris
S K
SK
Eades
J A
JA
Wilimas
D000279:Administration, Cutaneous; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D010166:Palliative Care
D000701:Analgesics, Opioid; D005283:Fentanyl