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Fentanyl

High alert medication

Controlled and targeted substance

Opioid analgesic

ACP: Moderate to severe pain

Contraindications:

  • Known hypersensitivity to opioids
  • Known or suspected bowel obstruction
  • Severe respiratory depression or airway compromise (asthma/COPD)

Caution:

  • Hypotension
  • Hypovolemia
  • Older adults may be more sensitive to the effects of opioids - consider reducing dose by half in patients over 65
  • Rapid infusions can lead to skeletal muscle and chest wall rigidity

ACP: Moderate to Severe Pain (E08: Pain Management)

  • Loading dose: IM/IV/IO: 0.5 – 1mcg/kg (Max dose 100 mcg); Usual dose: 25-50mcg q5 minutes prn (Max total: 300mcg/hour)
  • Loading dose: 1.5 – 2 mcg/kg IN (Max dose 100mcg); usual dose: 50-100mcg q 5 minutes prn (Max total: 300mcg/hour)
  • PR11: Intranasal Medication Administration

Once initial pain control is achieved, consider multimodal analgesia to support pain control

  • Maintenance dose for long conveyances: IM/IV/IO: 25 - 50mcg q 10 minutes prn; (Max total 250mcg/hour)
  • Maintenance dose for long conveyances: IN: 50 – 100mcg every 10 minutes prn; (Max total dose 250mcg/hour)

CliniCall consultation required prior to administration of higher doses

Follow weight-based dosing

NB: If vascular access is unavailable, the preferred route of administration for fentanyl is intranasal – intramuscular absorption rates are inconsistent in children.

ACP: Moderate to Severe Pain (E08: Pain Management)

Fentanyl is preferred over ketamine. Once initial pain control is achieved, consider multimodal analgesia to support pain control. 

  • Maintenance dose for long conveyances: 0.75 – 1.5 mcg/kg IN q 10 minutes prn; (maximum total 150mcg/hour)
  • Maintenance dose in long conveyances: 0.5mcg/kg q 10 minutes prn; (max total dose 150mcg/hour)

Inhibits ascending pain pathways in the central nervous system, altering pain perception by binding to opiate receptors, producing analgesia and euphoria.

IV/IO

  • Onset: Immediate
  • Duration: 30-60 minutes

IN/IM

  • Onset: 7-8 minutes
  • Duration: 1-2 hours

• Respiratory depression
• Nausea and vomiting
• Hypotension
• Bradycardia or tachycardia
• Hypotension/hypertension
• Hallucinations
• Anxiety
• Seizures

Provide airway management and ventilatory support.  Consider the use of naloxone to reverse opioid intoxication.  Naloxone should be used judiciously in patients on long-term opioid therapy to avoid precipitating acute withdrawal syndrome. 

See Naloxone guideline.

Concomitant use of benzodiazepines or other central nervous system depressants can lead to significant sedation and respiratory depression.

 

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