Coombes Lucy, Burke Kimberley, Anderson Anna-Karenia
Children and Young People's Outreach and Symptom Care Team, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, England, United Kingdom.
Children and Young People's Outreach and Symptom Care Team, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, England, United Kingdom.
Scand J Pain. 2017 Oct;17:256-259. doi: 10.1016/j.sjpain.2017.07.010. Epub 2017 Aug 10.
No published studies have looked at the dosing and use of rapid onset fentanyl preparations in children. The primary aim of this study was to assess whether there is a correlation between effective dose of rapid onset fentanyl and background oral morphine equivalent analgesia in children less than 18 years old. Secondary objectives included establishing whether there is a correlation between effective dose of rapid onset fentanyl and age and weight. Reported side effects were also reviewed.
This study is a retrospective case note review of all children less than 18 years old who received rapid onset fentanyl products in a tertiary paediatric oncology centre in England between 2010 and 2015. Correlations were analysed using Spearman's correlation coefficient as data was non-parametric.
Data on 26 children (5-17 yrs; 13-100kg) was analysed. The most common diagnosis in children being given rapid onset fentanyl products was a solid tumour (84.6%). Eleven children used sublingual tablets, 17 used lozenges and one used a fentanyl nasal spray (three patients used two different preparations). The only significant correlation found was between dose of fentanyl lozenge and weight (r=0.81, p<0.001). Very few side effects were reported with the most frequent being nausea (8%) and sleepiness (8%).
Fentanyl lozenges seem to be safe and well tolerated in children as young as five years old, weighing as little as 13kg. Results suggest that children should always be started on the lowest available dose of chosen preparation and that this dose should be titrated according to response. This study demonstrates that there is no correlation between background opioid dose and effective dose of rapid onset fentanyl in children. This mirrors findings of similar studies in adults. There was a strong correlation between effective dose of fentanyl lozenge and weight. This may be in part due to clinicians being more inclined to increase fentanyl lozenge doses as the child is in control of when they have had enough medication. In contrast, buccal tablets are absorbed quickly and the child always receives the full dose, making clinicians more reluctant to titrate the dose.
This article presents initial evidence for feasibility and tolerability of fentanyl lozenges in children as young as five years old, who are on relatively low doses of background opioids. This could be of interest to clinicians who are looking for alternatives to oral opioids to manage breakthrough pain in children with cancer.
尚无已发表的研究探讨快速起效芬太尼制剂在儿童中的给药剂量及使用情况。本研究的主要目的是评估18岁以下儿童快速起效芬太尼的有效剂量与背景口服吗啡等效镇痛之间是否存在相关性。次要目标包括确定快速起效芬太尼的有效剂量与年龄和体重之间是否存在相关性。同时对报告的副作用也进行了回顾。
本研究是一项回顾性病例记录回顾，研究对象为2010年至2015年期间在英国一家三级儿科肿瘤中心接受快速起效芬太尼产品治疗的所有18岁以下儿童。由于数据为非参数数据，因此使用Spearman相关系数分析相关性。
分析了26名儿童（5 - 17岁；体重13 - 100kg）的数据。接受快速起效芬太尼产品治疗的儿童中最常见的诊断是实体瘤（84.6%）。11名儿童使用舌下片，17名使用含片，1名使用芬太尼鼻喷雾剂（3名患者使用两种不同制剂）。唯一发现的显著相关性是芬太尼含片剂量与体重之间的相关性（r = 0.81，p < 0.001）。报告的副作用很少，最常见的是恶心（8%）和嗜睡（8%）。
芬太尼含片在年仅5岁、体重低至13kg的儿童中似乎安全且耐受性良好。结果表明，儿童应始终从所选制剂的最低可用剂量开始用药，并应根据反应进行剂量滴定。本研究表明，儿童背景阿片类药物剂量与快速起效芬太尼的有效剂量之间无相关性。这与成人类似研究的结果一致。芬太尼含片的有效剂量与体重之间存在强相关性。部分原因可能是当儿童能够控制自己何时服用足够药物时，临床医生更倾向于增加芬太尼含片剂量。相比之下，颊含片吸收迅速，儿童总是接受全剂量，这使得临床医生更不愿意滴定剂量。
本文为芬太尼含片在5岁左右、背景阿片类药物剂量相对较低的儿童中的可行性和耐受性提供了初步证据。这可能会引起正在寻找口服阿片类药物替代品来治疗儿童癌症突破性疼痛的临床医生的兴趣。
