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Fentanyl vs Morphine

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#1 steve_emt_68

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Posted 19 January 2009 - 02:51 AM

If a patient is already using a daily 75mcg Fentanyl patch wouldn't you want to continue with Fentanyl IV for pain control of a long bone fracture versus giving Morphine IV or am I missing something?
It just seems like going back to Morphine would be like putting out a forest fire with a syringe.
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#2 Arizonaffcep

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Posted 19 January 2009 - 03:27 AM

Not a bad idea, but there are some providers who can't push Fentanyl...For instance in Arizona medic's can't push Fentanyl, only morphine. At which point I would expect I would need to push a higher dose.
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#3 Ruffmeister Paramedic

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Posted 19 January 2009 - 12:38 PM

I think that if they are already on a fentanyl patch that they are going to want to add more fent but I think that they will be pretty tolerant of any additional fentanyl that you give them.

Adding morphine might be a good adjunct to the pain regimen.

But you can give more fentanyl than really morphine without worrying about their resp status.

I give a lot a fentanyl in the field so I'm sort of biased on fentanyl but if you do both then that's a better idea at least to me it is.
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#4 crotchitymedic1986

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Posted 19 January 2009 - 01:07 PM

I agree that anyone that is on a fentanyl patch daily, will have a high tolerance for any pain medication that you choose to administer, but you still have to worry about OD. I would remove the fentanyl patch, and continue with Fentanyl IV. Since it is shorter acting, you have less risk of OD, than you would with piling MS on top of the fentanyl and whatever other pain medications are already in their body. If you had a long transport time and the fentanyl wasnt working, you could then move on to the next med in your arsenal.
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#5 WelshMedic

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Posted 19 January 2009 - 01:50 PM

I would not agree with removing the patch is this case. The patch provides a baseline analgesia that can be continued. Any further pain relief can be titrated to the pt's pain. Just remember that anyone in a lot of pain will need a lot of analgesia.

Using set protocols and medication dosages just boils down to cook book medicine. I have been known to give a pt 25mg of Morphine without problems, if thet need it, they get it. Period.

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