Opioid intolerance in burn pediatric patients can be solved
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Pediatric burn patients typically undergo a large number of surgical procedures, resulting in significant pain. High amounts of opioids are continuously infused both during and after surgery in these patients, which in turn confers risk of the development of opioid tolerance. The intraoperative use of methadone, a synthetic opioid with unique pharmacologic characteristics, in a pediatric patient who had suffered significant thermal burns.

Clinical pearls:

The patient was a 5 year old male who was admitted to the burn ICU with approximately 90% cutaneous burns of deep partial to full thickness burns. He underwent 27 surgical procedures over 2 years, including debridement and grafting, escharotomies, and amputations. Throughout the procedures, the patient received a variety of intraoperative analgesic drugs. The most commonly used intraoperative analgesics were fentanyl and hydromorphone. During 9 procedures, he received methadone, a synthetic opioid, alongside fentanyl and hydromorphone.

The objective of analysis was to determine whether methadone infusion affected total intraoperative opioid usage in this patient. The amount of opioid product used per minute of surgery was identified for each procedure. This metric was compared between procedures where methadone was used and procedures where methadone was not used. Based on this analysis, the procedures where methadone was used resulted in decreased total intraoperative opioid usage in this patient. Use of methadone in a patient undergoing serial surgical procedures can therefore potentially decrease rapidity of opioid tolerance development via decreased intraoperative opioid use

Conclusively, pediatric burn patients require significant amounts of opioid products for pain, leading to opioid tolerance and subsequently elevated risk of adverse effects. Methadone can potentially provide adequate anesthesia and attenuated opioid tolerance compared to other commonly used opioid agonists, making it an enticing candidate for use in the pediatric burn population.

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