Dilaudid vs. Fentanyl?

[EmeraldNYL, BSN, RN]

In my ICU for sedation/pain management we usually use Fentanyl gtts, but recently I have been seeing more Dilaudid gtts. My orientee asked me the other day which medication was stronger, and what is the advantage of using one over the other?

I really didn't have a good answer for her.

Can anyone compare/contrast the 2 drugs for me?

I know they are both much stronger than Morphine.

I'm looking forward to taking the Pain Management course as part of my MSN program! Thanks guys.

[NRSKarenRN, BSN, RN]

Drug interactions between Dilaudid and fentanyl

Mayo Clinic Minute: Benefits, dangers of fentanyl

OPIOIDS – EQUIANALGESIC DOSAGES

OPIOID CONVERSIONS CALC (SINGLE AGENT) EQUIANALGESIC

[NRSKarenRN, BSN, RN]

Pain & Palliative Care

Using Opioids Safely for Cancer Pain

Clinical Nursing

[Tenesma]

1) Fentanyl has a long half-life, but has a short duration of action due to its lipophilic structure and rapid redistribution - hence the advantage of using it in conscious sedation, but if you run it as a drip you fill your reservoir and then the long half-life comes into play thus making a fentanyl drip in the ICU setting equivalent to a dilaudid drip (from a pharmacokinetic point of view).

2) All three have active metabolites, that is how they work, however you are right that fentanyl and dilaudid are cleaner than morphine, in as much as morphine as a metabolite that can accumulate in the setting of renal dysfunction.

[wwwilly3]

I HAd surgery last Friday a repeat of a surgery I had lst Sept. It was a cervical disc de-compression. I checked into pre-op at 10:00 Am as directed. To make a long story short an emergency brain absess went before me. So I was stuck in pre-op for 8 hours. The gave me fentayl twice without results. I told them fentanyl never has worked for me. They then gave me demoral which worked fine. I awoke from surgery and they have me hooked up to PCA with fenanyl. Needless to say I suffered without pain relief for the next 12 hours without and sleeep or relief. I asked to see the charge nurse and explained that something needed to be done or I would just go home. The Doctor whows up 12 hours later and puts me on Demoral/vistiril with great results. I was released today. I for the lfie of can't understand how tis could happen. One nurse also gave me vistiril IV and it almost burned my arm off. Thank God the surgery went well.

[Ginger Curry RN]

The question asked of you as to the strength difference between Dilaudid and fentanyl is vague; and, ought to be restated into a concrete question such as: degree of pain relief? or, equianlgesic dose? or, drug onset? or, drug duration? Only then, could you give an accurate answer. Dilaudid (hydromorphone) and fentanyl (sublimaze) each potentially produces the same degree of pain relief. Dilaudid (hydromorphone) equianlgesic dose is 0.15 mg; whereas, fentanyl (sublimaze) equianlgesic dose is 10-25 mcg. The onset is different: Dilaudid (hydromorphone) 2-5 minutes; fentanyl (sublimaze) 1-2 minutes. The duration is different: Dilaudid (hydromorphone) 2-4 hours; fentanyl (sublimaze) 1-1.5 hours.