Fentanyl

[Sasha]

We don't carry fentanyl, but I've heard a lot of good stuff about it. What would be the positives to fentanyl over morphine? The drawbacks? Does anyone favor one over the other?

[Mogollon]

Fentanyl (Sublimaze) is actually an ideal medication for the pre-hospital environment IMHO.

Unlike morphine, fentanyl is a very "clean" medication. As we know, morphine is rather "dirty" and is associated with histamine release. This histamine release can be associated with rather profound hemodynamic changes, hives, and itching. However, the synthetic fentanyl is not associated with any of these problems. Of primary importance for us being the fact that fentanyl, even in large doses (3 mcg/kg) will not typically drop blood pressure. Anybody who has seen cardiac anesthesia cases may notice the anesthetist giving doses of fentanyl in milligrams.

Therefore, I believe the hemodynamic stability, short duration, and effectiveness make fentanyl a choice agent for pre-hospital pain management.

[wvditchdoc]

^^^^^What he said.

[StreetDoc67]

In addition to the hemodynamic advantages Fentanyl actually has a much greater analgesic effect than morphine as well as a shorter duration of action, so it won't mask symptoms as long once you get the patient to the ED.

[wvditchdoc]

That is one thing I never personally bought, the whole masking thing. If a Doc is worth his/her salt, the exam will reveal what is needed regardless. It is along those lines of not giving MS for abdominal injuries, blah, blah, blah.

Just my thoughts, anyway....we now return you to your regularly scheduled programming.

[StreetDoc67]

I agree, but that is still a point medical directors like to make.

[wvditchdoc]

True enough,

[Dark Angel]

I agree, but that is still a point medical directors like to make.

I am so very fortunate to not have one of those medical directors. His opinion is that if they rate their pain a 3 or greater, give them something for it. He doesn't want us bringing patients into the ER in pain if a) we are an ALS staffed truck or b) there is nothing else going on with the patient that is more pressing and requires our immediate attention.

We used to carry morphine, but now carry fentanyl. I like that it doesn't have alot of the side effects that morphine does, but have found that just like any other med, it seems to work better for some than for others.

[Mogollon]

Interesting, the concept is very much a scarecrow relic from decades ago when physicians had to rely exclusively on the physical exam. However, with any index of suspicion, patients are sent to CT. In fact, large amounts of information exist that disprove the pain medication altering physical exam concept. If a medical director is advocating a concept that is clearly outside of best practice, we should confront (with tact and respect) them with the current evidence.

[wvditchdoc]

Question, is Phenergan given to potentiate Fentanyl as well? I have never personally used it and am not familiar.

Thanks....