# Fentanyl vs. Morphine



## MedicPrincess (Feb 8, 2008)

Currently, on our trucks we carry Toradol and Morphine as our pain control options.  Very soon, we are adding Fentanyl as a third option.

Simply put, for what kind of pt would Fentanyl be a better choice vs. Morphine?  

Obviously, a pt allergic to Morphine would get the Fentanyl.  However, is one better for...say as an example orthopedic/isolated fx pain....vs the other.   

Would Fentanyl be a better choice for someone who is bordering on hypotensive?

Fentanyl has such a "knock'em out" effect on the pts I have seen it used on.  The ER physicians already nearly come unglued at times when we have "altered" them with Morphine....I hate to see the first time I dose them up with Fentanyl.

Opininons?  Preferences?  What do you think?


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## Flight-LP (Feb 8, 2008)

Personally, I prefer Fentanyl over Morphine except in burn pts. Its stronger and seems to work a little quicker which is what I seek in my pain pts. If Fentanyl doesn't work, I'll add Morphine for a potentiation effect. Forcing a physician to actually put his hands on a pt. and utilize a little skill in diagnosing doesn't affect me. Honestly I could care less about what the doc thinks, I'm focused on reducing my pts. discomfort. The doc can just deal with it. I routinely bring pts. to the ER with 20 of Morphine or 200+ of Fentanyl. They are drugged until they drool!

btw, we also add Nitrous to the mix. Our pts. are well medicated! If I ever get injured, I hope it is within our territory!


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## johnrsemt (Feb 9, 2008)

we went from Morphine to Fentanyl; because it doesn't affect BP or respiratory drive like Morphine.

    My experience is that it takes pain out,  as LP says,  makes them drool.

    I had a pt that in a 2 year span, ran each hand through his table saw, major klutz, job security;  one of our fire fighters got a great price on a used table saw:       first time, morphine made his pain go down but still there (10mg).    2nd time: 100mcg fentanyl his response was "what hand?!?.

   never seen a pt allergic to it.   Had people slow there resp rate down, due to the pain going down, but not to a point of worrying about it.


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## spidermedic (Feb 9, 2008)

We carry both and I simply don't use morphine anymore.

Fentanyl seems to give better pain control, causes less nausea, does't drop pressure and has a shorter half life.

What's not to love.

We carry Nitronox as well, but I generally only use that to reduce patellas and such.


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## bonedog (Feb 11, 2008)

I find entonox works well if "sold" properley.
Fentanyl for any BP problems, MOS for the rest.

M&M with a little NOX till they drop the reg and you can relocate any #dislocation.


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## mtmedic (Mar 12, 2008)

We carry both as well and were instructed that fentanyl is indeed a better choice for traumatic injuries.  I have used both and have mixed results.  I like the fentanyl due to many of the above mentioned reasons but one drug does not work on all pts as some of you stated with ms.  i believe this to be a two street.  ultimately my goal per medical direction is to reduce pain.  If I start with one they now want us to call before we switch to the other.  I sure there is a story behind this but as usual it is above my paygrade.    We even have to call now when mixing up the benzos with the analgesics.  :wacko:  

I hope we will regain that latitude but who knows.  I do know that cookbook medicine is not what I am about.  We are no where near that (at least I don't think so) but should that approach it is time for me to sign off and find new work.


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## tydek07 (Mar 12, 2008)

We carry Morphine.

I see this question asked all over the place.

Morphine or Fentanyl? and Why?

I personally like Fentanyl over Morphine for prehospital. One of the big reasons is that Fentanyl does not effect BP/Resp. as does Morphine. I also find that Fentanyl is faster acting and has a shorter half life. So for pain control in the EMS feild I go for Fentanyl. 

Now for the Hospitals, I think Morphine is a better drug. It is more easily controlled in the hospital and it acts longer. So A+ for hospital use.

As for feild use: Doesn't mess with BP or Resp. as morphine does (A+), Faster acting (A+), Shorter half life (A+).

So thats kinda my take on this topic.
                                                                Tyler


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## triemal04 (Mar 13, 2008)

tydek07 said:


> We carry Morphine.
> 
> I see this question asked all over the place.
> 
> ...


And this is why people need to know about drugs before they ever consider giving them.  I mean dear god...pleasepleasepleaseplease don't try and tell me that 1)you're actually giving people fentanyl, and 2)that you actually think that it doesn't affect someone's respirations.  

I will at least say that it does have a much shorter lasting duration (good and bad for some services), has faster onset, and doesn't affect the BP as much as morphine (tell me why morphine does for brownie points) so you weren't all wrong, but you did screw up the most important part:  Fentanyl is still a narcotic.  It will still cause respiratory depression when given in the right dose.  Which means that if you screw up and give to much, you'll be smacking yourself just like if you'd given morphine.


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## johnrsemt (Mar 13, 2008)

*new protocols*

new for this year; starting March 1st

   We can give Fentanyl (and Narcan, and Versed); Intranasally.   which I have done 1 time and it is wonderful.  hard stick; pt in lots of pain.  gave her 100mcg Fentanyl.   she started complaining that it gave her a lousy after taste, and by the time that was over; the pain was going away.


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## fma08 (Mar 13, 2008)

gotta go with the fentanyl, again cuz of the lesser side effects than morphine, i.e. less BP problems, shorter half life also yes, it is much more potent of a pain killer than morphine, fentanyl does have a bit of a knock em out effect, even our protocol dose of 1mcg/kg can snow a pt. quite easily, especially the elderly, so as will all other narcs, very important to watch respirations and an SpO2 monitor is always good along with the close eye.


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## tydek07 (Mar 13, 2008)

triemal04 said:


> And this is why people need to know about drugs before they ever consider giving them.  I mean dear god...pleasepleasepleaseplease don't try and tell me that 1)you're actually giving people fentanyl, and 2)that you actually think that it doesn't affect someone's respirations.
> 
> I will at least say that it does have a much shorter lasting duration (good and bad for some services), has faster onset, and doesn't affect the BP as much as morphine (tell me why morphine does for brownie points) so you weren't all wrong, but you did screw up the most important part:  Fentanyl is still a narcotic.  It will still cause respiratory depression when given in the right dose.  Which means that if you screw up and give to much, you'll be smacking yourself just like if you'd given morphine.


Hey,
   That was my own fault. Bad wording. I was trying to say that if you would give the correct dose of Morphine, and the correct dose of Fentanyl... the morphine would effect the Resp. Drive more-so then the Fentanyl would. Now that I read through what I typed earlier, I kinda made it sound like it does not effect the Resp. Drive at all.


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## Epi-do (Mar 14, 2008)

triemal04 said:


> I will at least say that it does have a much shorter lasting duration (good and bad for some services), has faster onset, and doesn't affect the BP as much as morphine (tell me why morphine does for brownie points)



Can I try?  How about this?

Morphine is a pure opioid agonist and fentanyl is a mixed opioid agonist.  This means that morphine will bind to both mu and kappa receptors, but fentanyl binds with kappa receptors only and blocks the mu receptors.  Since fentanyl interacts with fewer total opioid receptors within the brain, you will have fewer side effects from it.

Then there is this one - morphine causes a histamine release, resulting in vasodilation.  Vasodilation = bigger containter = drop in BP.


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## Grady_emt (Mar 14, 2008)

Epi-do said:


> Can I try?  How about this?
> 
> Morphine is a pure opioid agonist and fentanyl is a mixed opioid agonist.  This means that morphine will bind to both *mu* and *kappa *receptors, but fentanyl binds with *kappa* receptors only and blocks the *mu* receptors.  Since fentanyl interacts with fewer total opioid receptors within the brain, you will have fewer side effects from it.
> 
> Then there is this one - morphine causes a histamine release, resulting in vasodilation.  Vasodilation = bigger containter = drop in BP.




All this mu, kappa, alpha, beta, stuff makes me want to say, 
TOGA!!! TOGA!!! TOGA!!! TOGA!!!


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## Ridryder911 (Mar 14, 2008)

Okay here is one... Fentanyl and Morphine are both analgesics but as with any medication there is s/e and undesired effects. It is up to the *provider* to *know* those and when it is best to NOT administer and WHEN TO administer either or both of them. 

Fentanyl is approximately 80 to 100 times stronger than Morphine. Yes, Morphine can cause drop in blood pressure (which can be good on some cases and bad on other). Also it has a nasty s/e called "stone chest wall syndrome" which can occur when given to fast, can actually paralyze the muscles of the chest wall preventing ventilation's. 

Again, it is up to the provider to be aware of the pharmacological effects of all their medications that they use. As well, the "best" for the patient dependent upon the need at the time. 

R/r 911


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## MedicPrincess (Mar 14, 2008)

So we have had the Fentanyl for about a month now.  I have used it 3 times....67 y/o with ankle fx, 13 yo clavical fx, 15 yo hip dislocation.

The only problem I had was in the 67 yo it did seem to cause a drop in her BP, however not so much as with the Morphine.

None of the 3 reported the nausea that seems to come everytime Morphine is given.

I have started low, 50mcg initial dose.  Only in the 13yo did I need to give the additional 50mcg.  The other two were good.  The 15yo was certain he could play the next game in the tourny.  Got to the ER and he was telling his dad to call the coach and let him know he would be back.  This was the change from the don't touch it, don't touch me of 15 minutes before.


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## triemal04 (Mar 14, 2008)

tydek07 said:


> Hey,
> That was my own fault. Bad wording. I was trying to say that if you would give the correct dose of Morphine, and the correct dose of Fentanyl... the morphine would effect the Resp. Drive more-so then the Fentanyl would. Now that I read through what I typed earlier, I kinda made it sound like it does not effect the Resp. Drive at all.


Ok, no worries, mistakes are part of learning.

If you have the option to use both just bear in mind that both can decrease the respiratory drive, even in comparable doses (50mcg of Fentanyl is roughly the same as 5mg of MS).  And yes, there are quite a few people out there who tolerate higher doses of fentanyl than they do of morphine with less respiratory depression, but do not base all your treatements off of a few or assume that everyone can handle a bigger dose with fewer complications; that's setting yourself up for failure.  It's not uncommon that I've given 200+mcg's without serious complications, but it's also happened that I've given 50mcg to an otherwise healthy person and then had to get a bit busy for awhile.  

If you haven't figured it out from the doses, fentayl is extremely powerful compared to morphine, and while it is the **** as far as I'm concerned, it's not a wonder drug that we can push without side effects.


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