Transdermal fentanyl provides an alternative route for children with relatively constant pain who require larger doses of opioid analgesia. It is unsuitable for rapid-dose titration or for any patient with changing pain intensity. Currently-available preparations do not permit the delivery of drug at dosage rates low enough for young children. Schedule and dose. Severe pain is an emergency, requiring the rapid titration of analgesia to provide relief within a few hours.
Rapid titration involves frequent assessments and dosage adjustments.
Unless the pain is truly intermittent and unpredictable, as-needed administration should not be used since delay between the request for medication and the administration results in poor pain management. Initial dose intervals are the same as those recommended for adults. Because four or five half-lives are required to reach a new steady state, increasing the infusion when pain is poorly managed will not by itself provide adequate, immediate relief. In fact, it could result in the administration of an unnecessarily large dose as soon as the infusion reaches a new steady state. Morphine is the preferred starting agent for severe pain.