How much Fentanyl

Hockey said:
Speaking of intranasal, someone mentioned you can get pain relief a little faster giving it IN than IV with Fentanyl because of the proximity to the brain and the receptors? Sounds good, but I'm curios to see if there is actually any science behind that?
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Agreed.

Just personal experience but IN fentanyl has only ever worked the way I wanted it to in kids, adults it never seems to work.
 
A great many thanks to everyone for their responses. They are all helpful!
 
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NYMedic828 said:
Wish I worked in a system that advocated pain management.
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I feel your pain..sort of. When I was a uni student doing placements, I ran into some truly shocking attitudes to pain relief and watched several pts scream in pain because the attending paramedic was too stupid to do anything about it. It sucks. Fortunately most of the people I work with aren't complete idiots. Eg The last pain pt I had was a bloke with pain from ?cervical nerve impingement. He got 25mg IV morphine, 250mcg IN fentanyl, methoxyflurane and 400mg ibuprofen and a heat pack before we even moved him. This is not by any means revolutionary here. He was a happy camper when we finished with him.

While I like that we're aggressive with pain relief and we basically just keep dosing people until they're happy, I'd love some other options like ketorolac, ketamine (coming soon for ICPs) and maybe IV paracetamol or some PO or longer term options. The literature supports these ideas, its just a challenge squeezing the money out of an already stressed system.

Hockey said:
Speaking of intranasal, someone mentioned you can get pain relief a little faster giving it IN than IV with Fentanyl because of the proximity to the brain and the receptors? Sounds good, but I'm curios to see if there is actually any science behind that?
Click to expand...

Sounds like rubbish to me. Certainly isn't true of my anecdotal experience. IV being almost instantaneous and IN taking several minutes.


NVRob said:
Agreed.

Just personal experience but IN fentanyl has only ever worked the way I wanted it to in kids, adults it never seems to work.
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I hear alot about how IN fent doesn't work. I think there are a few fixes for this issues. As I've said before, you can't just squirt your IV dose up their nose and hope it dose the trick. I've had a lot of success with IN fent with particular administration techniques and with doses usually >300mcg. Giving doses like this also raises problems in terms of concentration. You can't give a 250mcg loading dose if the concentration you're working with is 100mcg/2mls. Seriously, break out a mucosal atomiser and 5mls of saline and see how much of it runs down the back of your throat; largely wasted if it were fentanyl. We use 600mcg/2ml and I feel we still have troubles in doses >100mcg (.45mls including an addition for dead space of the atomiser, and they have to be split between nostrils). Which brings me to another point, you've got to use an atomiser and you have to account for the dead space or at least re-spray it such that you get the whole lot.

I think the IN route is incredibly useful when used properly.
 
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