Morphine v. Fentanyl

[firemedic7982]

Just a "Just because" thread.

Morphine, or Fentanyl for Traumatic Pain Management.
Keep in mind... Barring getting too technical in playing the "what if" game.
Just a question of peoples personal prefferences generally speaking.

If you carry something other... your opinion on those too.

 

[Epi-do]

At my full-time job, we only carry fentanyl, so I guess that makes it my choice by default.

At the part-time gig, we have both, but can only give morphine if they are allergic to fentanyl.

I have seen one work just as well as the other for various patients, so I can't really even say based upon anecdotal observations that one seems to work better than the other.

 

[firemedic7982]

I agree that it is hard to say that one works better than the other.

More a question of personal prefference really.

 

[irish_handgrenade]

i prefer morphine on longer transport times and in cardiac patients. fentanyl for musculoskeletal pain and shorter transport times. obviously if the pt is allergic to one I'll give the other.

 

[Amack]

I prefer Morphine. Although, Fent has it's advantages in trauma situations

 

[omak42]

Where I work morphine works a little bit better for most patients because of our transport times. We used to carry morphine then switched to fentanyl a couple months ago and we frequently have to call for orders to go over the max dose (200mcg). At the doses we give it fentanyl is shorter acting so we need to constantly redose throughout our transports which are usually longer than 30 min. However I wouldnt say that there is enough to prove that morphine works better on pain management then fentanyl (like a lot of people seem to think).

 

[firemedic7982]

It is my experience, that fentanyl seems to do better with orthopaedic injuries. Morphine for cardiac, and pt. prefference always plays a factor as well.

 

[MSDeltaFlt]

All meds should be weight based. As far as weight basing goes, Fentanyl hands down. It's more powerful and not as much of a tendency to lower BP. Also, fewer allergies than to morphine.

 

[Aidey]

I prefer morphine, anecdotally it seems to have a faster onset, stronger affects and last longer. As someone else mentioned, it's easy to max out a patient on fentanyl if patient is large and transport more than 10-15 mins.

Morphine does have a stronger affect lowering blood pressure, which sometimes made it a poor option for a patient, so fentanyl is a good option to have in those cases.

Personally, I loved having morphine and nitrous. I would actually like fentanyl a lot more if we also carried nitrous. That way we can use the nitrous to take the edge off while waiting for the fentanyl to kick in, and the patient can use it to agument the pain releif offered by the fentanyl, possibly allowing us to give smaller doses.

 

[firemedic7982]

I prefer morphine, anecdotally it seems to have a faster onset, stronger affects and last longer. As someone else mentioned, it's easy to max out a patient on fentanyl if patient is large and transport more than 10-15 mins.

Morphine does have a stronger affect lowering blood pressure, which sometimes made it a poor option for a patient, so fentanyl is a good option to have in those cases.

Personally, I loved having morphine and nitrous. I would actually like fentanyl a lot more if we also carried nitrous. That way we can use the nitrous to take the edge off while waiting for the fentanyl to kick in, and the patient can use it to agument the pain releif offered by the fentanyl, possibly allowing us to give smaller doses.

+10 on the Nitrous.

 

[DV_EMT]

actually,

i'd nix fentanyl and morphine and just go with some dilaudid (hydromorphone). technically it is a form of morphine, but it has less N/v symptoms that normal morphine has.

however, at our hospital, surgery (pre op) usually uses fentanyl and post op usually uses dilaudid.

but it all depends on the patient if you ask me.... no two are alike!

 

[emtjack02]

In my practice I see more N/V w/ Dilaudid vs MS.

 

[trevor1189]

This is off topic but, I was on a ride along for a fall victim with a hip out of place. Medic got an order for Fentanyl and administered enroute. When we got the the ER, I said is the medication helping your pain? She said yeah it was starting to help. As we were pushing her into the ER she looked to her right and said what's that? The medic replied that's a wall and just looked at me with a smirk.

I'd say she was free of pain and probably a little high. Lol

Also, I don't know the calculation for dosing, but I have heard that Fentanyl is easier to calculate.

 

[emtjack02]

most calcs/dosing I've seen for fentanyl 1mcg/kg. Although one should go by their protocols.