Fentanyl and Combat medicine

Breakthrough pain

Sublingual administration of fentanyl dissolves rapidly and is absorbed through the sublingual mucosa, providing rapid analgesia.

Fentanyl is a highly lipophilic compound,well absorbed sublingually and is generally well tolerated.This modality is particularly useful for breakthrough cancer pain episodes,which are often rapid in onset, short in duration, and severe in intensity.

Palliative care

In palliative care,transdermal fentanyl patches have a clear but limited role for:

Individuals who are already on stable use of other opioids but have persistent swallowing problems and cannot tolerate other parenteral routes (eg, subcutaneous administration).People with moderate to severe kidney failure.Troublesome side effects of oral morphine, hydromorphone, or oxycodone.When using transdermal patches,patients must be careful to minimize or avoid external sources of heat (direct sunlight, heating pads, etc.),which can trigger excessive drug release and absorption with potentially fatal complications.

Combat medicine 

Fentanyl lozenges in the form of lollipops are used by U.S. Air Force paratrooper rescue teams in Afghanistan to treat combat casualties from improvised explosive device explosions and other trauma.The stick is attached to the finger, and the lozenge is placed on the person’s cheek.When enough fentanyl has been absorbed, the (sedated) person will often let the lollipop drop from the mouth, indicating adequate analgesia and somewhat reducing the likelihood of overdose and associated risks.

Difficulty breathing

Fentanyl may also be used in patients who cannot tolerate morphine or who have dyspnea that does not respond to morphine. Fentanyl is particularly useful as a concomitant treatment in palliative care,where pain and shortness of breath are severe enough to require treatment with high-intensity opioids.

Other

Some routes of administration, such as nasal sprays and inhalers, often result in faster high blood levels, which can provide more immediate pain relief, but also have more serious side effects, especially in overdose.Some of these appliances cost significantly more than oral or oral options and may not be justified by marginal benefits.Intranasal fentanyl appears to be as effective as intravenous morphine but superior to intramuscular morphine for acute hospital pain.The Fentanyl Patient-Controlled Transdermal System (PCTS) is being developed to allow patients to control the administration of fentanyl through the skin to treat postoperative pain.The technology consists of a “preprogrammed self-contained drug delivery system” that uses electro-delivery technology to deliver 40 micrograms of fentanyl hydrochloride on demand within ten minutes.In a 2004 trial of 189 patients experiencing moderate to severe postoperative pain up to 24 hours after major surgery, 25% of patients withdrew due to inadequate analgesia.However, the PCTS method proved to be superior to placebo, showing lower mean VAS pain scores and no significant respiratory depression.

Negative Effects

The most common side effects of fentanyl affect more than 10% of people and include nausea, vomiting, constipation, dry mouth, drowsiness, confusion, and weakness (weakness). Less commonly, in 3-10% of people, fentanyl can cause abdominal pain, headache, fatigue, anorexia and weight loss, dizziness, nervousness, anxiety, depression, flu-like symptoms, dyspepsia (dyspepsia), Shortness of breath, hypoventilation, apnea, and urinary retention. Fentanyl use has also been linked to aphasia.Although fentanyl is a more potent analgesi,it tends to cause less nausea than morphine,as well as less histamine-mediated pruritus.Fentanyl’s duration of action is sometimes underestimated, leading to medical harm.In 2006, the U.S.Food and Drug Administration (FDA) began investigating several respiratory deaths, but physicians in the U.K. were not informed of the risks of fentanyl until September 2008. warn.The FDA reported in April 2012 that 12 young children had died and 12 others had become seriously ill as a result of separate accidental exposure to fentanyl skin patches.