[Methadone vs Fentanyl Patch for Prevention of Agitation in Intensive Care Patients: A Before-After Intervention Study].

BACKGROUND

Many mechanically ventilated intensive care unit (ICU) patients receive continuous infusion of intravenous opiates for pain relief and sedation. Upon cessation of these infusions to wean the patient from mechanical ventilation, withdrawal symptoms may ensue. For prevention, long-acting opiates, such as oral methadone or transdermal fentanyl, may be used.

OBJECTIVES

To compare the number and intensity of agitation episodes, admission times, ventilation days, and the need for physical restraint between patients who received methadone vs transdermal fentanyl.

METHODS

This retrospective study involves data retrieval from the computerized systems of patients who were admitted to the ICU at Meir Medical Center in Kfar Saba, Israel, between 2020 and 2022, and received either enteral methadone (49 patients) or a fentanyl patch (50 patients).

RESULTS

No statistically significant differences were found between the groups in the number and intensity of agitation episodes, admission times, ventilation days, and physical restraint. A statistically significant difference was found in the need for agitation rescue drugs, which was higher in the methadone group.

CONCLUSIONS

No drug had an advantage in most of the parameters measured, excluding the higher need for agitation rescue drugs in the methadone group.

DISCUSSION: Data regarding fentanyl patches in ICU patients are scarce. Here, methadone did not have an advantage over fentanyl patch in admission or ventilation times and agitation prevention. Choice of therapy should therefore rely on other considerations, including ideal drug route and adverse effects. Methadone and fentanyl patch are equivalent in terms of agitation prevention, except for a higher need for agitation rescue drugs in the methadone group.