How Much Fentanyl?

RNZenpeaceful · Jan 24, 2006

That depends on the situation...I worked in an ER. To treat an awake, alert, 27 y/o women, about 150 pounds, 25 mcg IV ordered for a severe migraine headache..pt achieved complete pain relief, without signs of slurred speach, unsteady walk, etc. To reduce displaced shoulder in a 32 y/old, 200 pound man...50 mcg IV plus 2 mg IV Versed ("conscious sedation")...same dose was repeated after 15 minutes, because patient kept screaming in pain..after the second dose was give, shoulder was reduced properly...patent was monitored closely under conscious sedation protocol, did well, and discharged to home about 2 hrs later with family member to drive him home..3rd situation: 35 pound 3 year old buy needed sutures under chin...100 mcg oralet lollypop, child remained awake and cooperative, (possibly "seeing/hearing things"but not at all upset, and smiled or even laughed during the procedure-also under close conscious sedation protocall)...

athena55, BSN, RN · Jan 24, 2006

Hi there! Well, it depends on which type of Fentanyl you are using: Fentanyl transdermal, injectable, or the transmucosal.

[the patches release anywhere from 25 mcq, 50 mcq, 75 mcq, or 100 mcq of Fentanyl per hour. each patch is changed or applied every 72 hours, but you probably know that]

I would hope that, before any type of pain medication is ordered or offered, the health care provider would assess the inferred pathophysiology or the mechanisms that may be responsible for the pain the person if experiencing (nociceptive pain, neuropathic pain, or idiopathic pain)

What type of pain medication has your patient received in the past, and how effective was it/wasn't it?

to manage chronic pain alot of pain management providers would start therapy with the 25 mcq/hour transdermal system and adjust the dosage prn and as tolerated. Onset of action is 12-24 hours and peaks within 1-3 days, duration varies.

May I ask, what type of pain medication has your patient been receiving? Oftentimes many health care providers under medicate their patients because they don't want the patient to become "addicted or dependent". As many may know, there are two types of dependency: physiological and psychological. The former means the body becomes more tolerant of the dosage and over time, increase in the dose or adding a different type of pain medication is needed.

There is an excellent website maintained by Beth Israel Medical Center's Pain and Palliative Care Unit, NYC. Maybe if you get the chance check it out. www.stoppain.org

Good luck!

SmilingBluEyes · Jan 24, 2006

In OB, we used anywhere from 25-100 mcg q2-4 hours. They had to be on pulse ox while fentanyl in use.

I say "used" cause the last two facilities I have worked do not use it except in the epidural/intrathecal route. We use Nubain or Stadol for IV pain meds. Never had heard of fentanyl patches in OB use as they are for longer-term use.

rpbear · Jan 24, 2006

We use 50-100 mcg Q1 hour for labor max dose 400 mcg. We also use it in epidural bags with ripivocaine but I don't know the dose off the top of my head.

I works well for labor pain, but it only last a short while. Baby's do OK if it is not given too close to delivery, but we still have narcan ready.

Gompers, BSN, RN · Jan 24, 2006

Just wondering, since I'm not an L&D (or even adult) nurse...

Do they ever use non-narcotic pain meds in labor? I had Toradol twice in the ER when I had kidney stones and it was amazing stuff. The second time, they were going to give me morphine or fentanyl (heard the doc and nurse discussing it) and I asked to have the Toradol again. They kind of looked at me funny - I mean, who turns down narcotics? But I am not a big fan of them, so I just wondered if that is an option in labor?

allnurses Guide · Jan 25, 2006

Thanks for the replies.

I should have been more specific. I was talking about a woman in labor and how much do you use.

There was a recent discussion about how much was too much - I can't go into details though.

HIPAA and all . . . :rolleyes:

steph

elliebellie · Jan 26, 2006

The last place I worked we gave 100mcg q hour x3. It was the only narcotic we gave IV. That 3rd dose really didn't help much unless they spaced it out much more than an hour.

Current place gives 50-100 mcg but we also have nubain as a choice & most of the nurses give that.

allnurses Guide · Jan 27, 2006

The last place I worked we gave 100mcg q hour x3. It was the only narcotic we gave IV. That 3rd dose really didn't help much unless they spaced it out much more than an hour.
Current place gives 50-100 mcg but we also have nubain as a choice & most of the nurses give that.

We don't give nubain or stadol . . .. . and we rarely give fentanyl.

I was surprised at the amount you gave at the last place you worked.

Funny thing - since coming to allnurses I've found that there are pretty large differences in medical practices.

Thanks for the info.

steph

mstigerlily · Jan 27, 2006

I am interested to know how much is too much too. I work in postpartum and I had a post c-sect patient come over recently that the L&D nurse described as having "major pain control issues". She had already been given 200 mcg of fentanyl and the nurse had called to get an order for dilauded and she had been given a few 0.5 doses of dilaudid as well - all within the 2 hr recovery period after a spinal duramorph. Frankly after hearing this I was concerned this woman had something else going on to cause that kind of pain - bowel or uterine perf, etc. She was very groggy, RR around 12-14 but just groggy but still complaining of pain!

I know that in recovery, they give a ton of IV meds but it seemed like so much to me. She was a young and anxious primap and when I spoke to her I realized the pain was just her perception of becoming aware of the incision and sensation returning. Educated the patient on what to expect after c-section including gas, soreness, getting up for the first time, reviewed allergies, reactions to anesthesia including this experience, etc. Then looked at the spinal orders I was thrilled to see that the anesthesiologist had ordered 1-2 percocet q6h and motrin q6h in addition to the IV meds. I love when they give us this option because I have noticed that for some reason oral percocet seems to work a lot better than IV morphine or dilaudid for c-sections so after a quick call to the anesthesiologist to make sure it was ok to start this early after recovery, I gave her 2 percocets and a motrin. Discussed pros/cons of this vs IV meds with her and her family and they agreed to try it. This woman had zero trouble with nausea but I gave her zofran IV prophylactically as well because she hadn't eaten in nearly 24 hrs and had a lot of meds on board. I checked on her throughout night (family at bedside) and within half and hour this woman was sleeping peacefully and remained at rest and comfortable till morning.

I came back the following night to care for her and she was doing great, spinal orders were up and she could now take this dose q4h and she was virtually painfree and very thankful for my care the night before. In fact, her family was thrilled to see me back. I have found that in OB, what the patient perceives as "pain" is sometimes just pressure (as in baby moving down) or sensation returning (spinal wearing off) and when this is explained and put into perspective, the patient doesn't need the pain meds at all.

Anyway, interested in hearing what prompted your question?

Thanks for the replies.
I should have been more specific. I was talking about a woman in labor and how much do you use.
There was a recent discussion about how much was too much - I can't go into details though.
HIPAA and all . . .
steph