Category:

• General Anesthetic

Description:

• Narcotic analgesic

Indications:

• Perioperative analgesia

• Adjunct to general anesthesia (alone or combined with droperidol)

• General anesthesia

• Chronic pain (transdermal)

Contraindications:

• Lozenge for child < 15kg

• Transdermal for child < 12kg

Precautions:

• Pregnancy category C

• Elderly, respiratory depression, increased intracranial pressure

• Seizure disorders, severe respiratory disorders, cardiac dysrhythmias

Adverse Reactions (Side Effects):

• CNS: asthenia, confusion, delirium, dizziness, euphoria, somnolence

• CV: bradycardia, hypotension or hypertension

• EENT: blurred vision, dry mouth, miosis

• GI: constipation, nausea, vomiting

• GU: urinary retention

• MS: muscle rigidity

• RESP: laryngospasm, respiratory depression

• SKIN: pruritis, sweating

Dosage:

Administered intramuscularly, intravenously, topically, orally

• Adult and Child >12 years

  • Chronic pain: 

    • TRANS 25 mcg/hr system initially; initial dose may be increased after 3 days, thereafter a minimum of 6 days should elapse between dosage increases; to covert patients already receiving other narcotics, refer to manufacturer product information; change system every 72 hours

  • Sedation for minor procedure: 

    • Buccal 5 mcg/kg (max 400mcg) 20-40 minutes before surgery

  • Preoperatively: 

    • IM 50-100mcg 30-60 minutes before surgery

  • Adjunct to general anesthesia: 

    • IM/IV 50-100 mcg/kg

  • Adjunct to regional anesthesia: 

    • IV 2-50 mcg/kg

  • General anesthesia: 

    • IV 50-100 mcg/kg with oxygen and a muscle relaxant

  • Postoperatively: 

    • IM 50-100mcg every 1-2 hours as needed

• Child 2-12 years

  • Sedation for minor procedure: 

    • Buccal 5-10 mcg/kg (max 400mcg) 20-40 minutes prior to procedure; children < 40kg may require doses of 10-15 mcg/kg (max 400mcg); do not use in child < 2 years

  • Adjunct to anesthesia: 

    • IV 2-3 mcg/kg

Note:

• IV/IM dose of 0.1 mg fentanyl equianalgesic to 10mg morphine, 75mg meperidine