A retrospective study was conducted to determine the patterns of strong opioid use in patients admitted to a hospice inpatient unit, with special attention to the use of the transdermal fentanyl patch. This study was conducted to validate or negate the subjective feeling that many patients, treated at admittance with the fentanyl patch, received inappropriately high doses compared to patients treated with oral or parenteral opioids. The case notes of 1154 patients were reviewed and data collected on age, sex, diagnosis, care settings, opioid form and dose on referral, maximal dose during admission and opioid use during the last 24 hours of their life. At admission opioids had been prescribed for 47% of patients. Thirty-two percent of these patients received oral morphine. The median dose at admission of those patients was 60 mg (oral morphine equivalent (OME)). Thirty-six percent of the patients on opioids were using the fentanyl patch. The median dose at admission was triple that of the orally treated patients (median 180 mg OME). In the 199 patients using transdermal fentanyl at admission, in most patients the dose of the patch was gradually diminished and finally stopped in 58% of patients. Only 83 kept it until the last 24 hours. We would like to draw attention to the fact that (sometimes inappropriately) high doses of fentanyl were used at admission, probably due to lack of knowledge of the relative strength of the opioid involved and to the failure to recognize the phenomenon of opioid-induced hyperalgesia. In addition, in our experience the long action of the patch can be a disadvantage during the last days and weeks of life, due to the difficulty of dose adjustment and the risk for toxicity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.