My son didn’t respond to the morphine at all when he had his surgery, so he was switched to a Dilauded pump at that time, with a steady Narcan drip to offset the itching side effect. This worked very well for him for the surgery & his 1st SCT. However, he suddenly developed an allergy to it when they began using it for his 2nd SCT, so they pulled the Dilauded & switched him to Fentanyl, still maintaining the Narcan drip as he had intense itching with the Fentanyl as well.
His first antibody therapy it took about 6 hours of him screaming in pain before they got his dosing right for the Fentanyl / Narcan steady drip, as needed, & rescue doses.
I feel I should mention he has a VERY high metabolism though & his body chews right through any med given. At 3 years old/35 lbs, he was on the same dose of some meds as a 17 year old football player down the hall from us. So he is complicated & leaves the dr’s / nurses scratching their heads at times as to how the doses they try do nothing or only give him relief for very, very short time spans. (All the meds prescribed for him when he was diagnosed at 2 1/2 doubled in dosage amount by his second round of chemo even.) So figuring out his dosage during the first round was likely effected by this too.
But he did great after that 1st round of antibody therapy in regards to managing the pain. That is until his 3rd round of antibody therapy, at which time he had retained so much fluid during the antibody therapy that the Fentanyl did not metabolize through him, like Dilauded or Morphine would have even with all the fluid retention. This caused him to have an opiad overdose since there was no way to know his body was doing this, as this has only happened a few times in the world, with adults, we were told. Thankfully, he was in my arms when his body OD & he began seizing, so it was caught immediately. They started CPR, & that combined with the Narcan already running, they were able to bring him back.
So I decided no Fentanyl again…ever. And he is now right back where he started & got Morphine the last 2 rounds & now it works amazing for him.
So, as a parent & doctor yourself, if you don’t think something is working for your child, my advice would be to just ask for another option. We were warned the 1st round is the worst as they figure out dosing, which it certainly was, but once they figured it out, the pain never got ahead of him/them again.