Tolerance and Withdrawal From Prolonged Opioid Use in Critically Ill Children
- 1 May 2010
- journal article
- review article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 125 (5), e1208-e1225
- https://doi.org/10.1542/peds.2009-0489
Abstract
OBJECTIVE: After prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal. PATIENTS AND METHODS: Relevant manuscripts published in the English language were searched in Medline by using search terms “opioid,” “opiate,” “sedation,” “analgesia,” “child,” “infant-newborn,” “tolerance,” “dependency,” “withdrawal,” “analgesic,” “receptor,” and “individual opioid drugs.” Clinical and preclinical studies were reviewed for data synthesis. RESULTS: Mechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia. CONCLUSIONS: Opioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.Keywords
This publication has 255 references indexed in Scilit:
- Extracellular signal-regulated kinase (ERK) inhibition does not prevent the development or expression of tolerance to and dependence on morphine in the mousePharmacology Biochemistry and Behavior, 2007
- Altered Basal Cortisol Levels at 3, 6, 8 and 18 Months in Infants Born at Extremely Low Gestational AgeThe Journal of Pediatrics, 2007
- Prevalence of UGT1A9 and UGT2B7 nonsynonymous single nucleotide polymorphisms in West African, Papua New Guinean, and North American populationsEuropean Journal of Clinical Pharmacology, 2006
- The d- and l- isomers of methadone bind to the non-competitive site on the N-methyl-d-aspartate (NMDA) receptor in rat forebrain and spinal cordNeuroscience Letters, 1997
- Morphine metabolism in acutely ill preterm newborn infantsThe Journal of Pediatrics, 1992
- Movement disorder after withdrawal of fentanyl infusionThe Journal of Pediatrics, 1991
- Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7-year-old childrenThe Journal of Pediatrics, 1991
- Neonatal opiate abstinence syndrome in term and preterm infantsThe Journal of Pediatrics, 1991
- Finding VeinsThe New England Journal of Medicine, 1981
- Use of propoxyphene napsylate for detoxification of a child with morphine sulfate tolerance and physical dependenceThe Journal of Pediatrics, 1978