Fentanyl

How it works

It is a strong mu-opioid receptor agonist, producing rapid analgesia and sedation with a fast onset and short duration after a single dose.

Prescribing in practice

• The dominant risk is dose-dependent respiratory depression, which can be profound and delayed, so it must be given with monitoring, resuscitation equipment and naloxone available and titrated carefully.
• Rapid intravenous administration can cause chest-wall rigidity impairing ventilation, and effects are potentiated by other sedatives and CNS depressants.
• Use weight-based dosing from a children's formulary and reserve transdermal formulations for opioid-tolerant children with stable chronic pain.

Monitoring

Continuously monitor respiratory rate, oxygen saturation, sedation level and blood pressure during and after administration.

Counselling the patient

• Drowsiness and slowed breathing can occur, so the child must be observed closely.
• Carers of children on patches should keep used and unused patches away from others and dispose of them safely.
• Report any difficulty breathing, excessive sleepiness or unresponsiveness immediately.

Evidence & guidelines

Fentanyl is widely used for paediatric procedural and perioperative analgesia, with dosing and monitoring directed by specialist anaesthetic and intensive care practice.