From the Guidelines
For a patient with persistent pain (7/10) who has already received IV morphine 2mg and has a codeine allergy, I recommend administering fentanyl 25-50mcg IV as an alternative opioid analgesic, as it is 100 times more potent than morphine and has a shorter onset of action, making it better suited to treat acute moderate to severe pain 1. This recommendation is based on the fact that people with morphine allergies do not have allergies to fentanyl, and fentanyl has a higher bioavailability due to its lipid solubility 1. Some key points to consider when administering fentanyl include:
- Monitoring the patient closely for respiratory depression, sedation, and hypotension after administration
- Coordinating pain management with the surgical team and anesthesiology, as the patient may be heading to surgery
- Documenting the patient's pain scores before and after administration to track effectiveness
- Being aware that a codeine allergy does not necessarily indicate cross-reactivity with other opioids, but using a different opioid class is prudent Fentanyl works by binding to mu-opioid receptors in the central nervous system, providing potent analgesia with a relatively rapid onset of action, making it suitable for acute pain management in the pre-surgical setting. It is also important to note that hydromorphone is another alternative, but fentanyl is preferred due to its quicker onset of action and higher potency 1. Overall, the goal is to provide effective pain management while minimizing the risk of adverse effects, and fentanyl is a suitable option for this patient.
From the Research
Patient's Current Condition
- The patient is still experiencing pain at a level of 7/10 despite being administered IV morphine 2mg at 9:58pm.
- The patient has an allergy to codeine.
Considerations for Alternative Pain Management
- Given the patient's allergy to codeine, alternative opioids or pain management strategies should be considered 2.
- Morphine has been administered, but its effectiveness and potential side effects should be closely monitored 3, 4.
- Other opioids like fentanyl, oxycodone, or heroin have different potency levels and potential for respiratory depression, which should be considered when selecting an alternative 5.
Potential Alternatives
- Meperidine (pethidine) has been shown to produce less nausea and vomiting and less respiratory depression than morphine in some studies 4.
- Buprenorphine, an opioid receptor agonist-antagonist, may have a lower risk of respiratory depression, but its analgesic efficacy is considered weak 3.
- Non-opioid pain management options, such as NSAIDs or paracetamol, could be considered, but their effectiveness may be limited compared to opioids 3.
Important Considerations
- The patient's age, gender, and race may influence the risk of side effects from opioid administration 4.
- Respiratory depression is a significant risk with opioid use, particularly in older adults 4, 5.
- A thorough evaluation of the patient's medical history and current condition is necessary to determine the best course of pain management 2.