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Discussion

fentanyl use in the ED

Anyone else use fentanyl in the ED for acute pain? We currently use it for most cons. sedations (with versed). We have a Doc that orders it a lot for acute pain with an order like: Fent. 50-100mcg iv q 20 min prn. Most pts with this type of order are ortho types(good for getting x-rays done),chronic pain med pts, stable traumas etc. Just wondering...

I like it b/c it seems less vasoactive and has less accumulative effects with multiple dosing r/t its short half life.

Kevin

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Good drug - we use it a lot in our ER

Fentanyl is a poor choice treating pain over the course of more than a few minutes. It's sedative effects will remain, but the pain control doesn't.

Fentanyl is best given to bring a pain crisis down, then long term pain control can be provided with MS04.

An example?

Patient comes in with a compound fracture and is 10/10 pain.

Start with a push of 50mcg's and repeat in 20mcg doses until pain is rated as a 4 or less. Once this occurs, give 1-2 of Dilaudid. (or MS04 if you're so inclined).

Dave

we seldom use Fentanyl for pain control in our ED, we use Morphine.

I agree with Dave. Fentanyl works way too short term in terms of pain relief. I prefer to use it briefly and follow with Dilaudid 0.2 to 0.4 mg IV in increments depending on weight and age. You can give Dilaudid IM 2mg in the meantime. Sometimes (I know this will cause an uproar here) a teensy bit of Demerol iv (10-25mg) can have an incredibly good effect as a synergyst.

Fentanyl IS good for brief pain, like cramping after a Dand C.

We use it with Versed for concious sedations at a 5:1 ratio.

we use all the differnt pain meds, and always in increasing dosages as the patients are all getting so tolerant of them.

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