Objective: To demonstrate the efficacy of a 10-day, single daily dose, enteral methadone weaning protocol for the prevention of opioid withdrawal symptoms in pediatric patients after prolonged fentanyl exposure.
Design: Prospective, observational study.
Setting: Twenty-four–bed medical-surgical intensive care unit within a 222-bed pediatric teaching hospital.
Patients: Twenty-nine children, aged 1 day to 19.8 yrs, who received methadone to prevent opioid withdrawal after prolonged continuous fentanyl infusion exposure.
Interventions: Institution of a standardized methadone weaning protocol.
Measurements and Main Results: All 29 patients had received a continuous fentanyl infusion; duration of exposure was 14.5 ± 9.2 days, cumulative fentanyl dose was 1.93 ± 1.53 mg/kg, and peak fentanyl infusion was 9.6 ± 4.3 μg/kg per hr. Twenty-five (86%) of 29 patients successfully completed the methadone wean in 10 days. Withdrawal complications that required a weaning delay were seen in three patients, and one patient expired before completion. Sixteen patients were discharged to complete their weaning schedule at home without incident.
Conclusions: Opioid withdrawal symptoms in pediatric intensive care unit patients after prolonged fentanyl exposure can be avoided by using an enteral, 10-day, single daily dose methadone weaning protocol.