Fentanyl also spelled fentanyl, is a highly potent synthetic opioid primarily used as an analgesic.Fentanyl and its analogs have been responsible for the majority of drug overdose deaths in the United States since 2018, accounting for more than 71,238 deaths in 2021. Since fentanyl is 50 to 100 times more potent than morphine, its main clinical use is in pain management in cancer patients and those recovering from painful surgical procedures.Fentanyl is also used as a sedative.Depending on the mode of administration, fentanyl may have a very rapid onset of action and ingestion of relatively small amounts may result in an overdose.Fentanyl works by activating mu-opioid receptors.Fentanyl is also commonly known as Fentanyl Citrate, Sublimaze, Actiq, Duragesic, Fentora, and Matrifen.
The side effects of the drug fentanyl are similar to those of other narcotic opioids and include euphoria, confusion, respiratory depression (which may cause breathing to stop if widespread and untreated), drowsiness, nausea, visual disturbances, movement disturbances , hallucinations, delirium, a subset of the latter called “narcotic delirium”, analgesia, narcotic ileus, muscle rigidity, constipation, addiction, loss of consciousness, hypotension, coma, and even death.Alcohol and other drugs (ie, cocaine, heroin) can synergistically exacerbate the side effects of fentanyl. Naloxone (also known as NARCAN) can reverse the effects of an opioid overdose; however, because fentanyl is so potent, multiple doses may be required.Fentanyl was first synthesized by Paul Janssen in 1959 and approved for medical use in the United States in 1968.In 2015, 1,600 kg (3,500 lb) were used in healthcare worldwide. As of 2017, fentanyl was the most widely prescribed synthetic opioid in medicine in 2019, it was the 278th most commonly prescribed drug in the United States, with over one million prescriptions.It is on the World Health Organization’s list of essential medicines.
Fentanyl continues to fuel the epidemic of synthetic opioid overdose deaths in the United States. While deaths from prescription opioids remained stable from 2011 to 2021, deaths from synthetic opioids increased from 2,600 overdose deaths per year to 76,238 per year.Since 2018 when fentanyl overtook heroin, fentanyl accounts for the majority of all drug overdose deaths in the United States.The National Forensic Laboratory estimates that federal, state, and local forensic laboratory reports of fentanyl have increased from 4,697 reports in 2014 to 117,045 reports in 2020.Fentanyl is often mixed, cut, or ingested with other drugs, including cocaine and heroin.Fentanyl has been reported in pill form, including pills that mimic drugs such as oxycodone.Mixing with other drugs or masquerading as a drug makes it difficult to determine the correct treatment in the event of an overdose, leading to more deaths. Fentanyl’s ease of manufacture and high potency made it easier to produce and smuggle, resulting in fentanyl displacing other narcotics of abuse and becoming more widely used.
Intravenous fentanyl is usually used for anesthesia and pain relief.To induce anesthesia, it is used together with sedative-hypnotics (such as propofol or thiopental) and muscle relaxants.To maintain anesthesia, an inhaled anesthetic with additional fentanyl can be used.These are typically performed at 15-30 minute intervals throughout procedures such as endoscopy and surgery and in the emergency room.To reduce pain after surgery, use an inhaled anesthetic that can reduce the amount of anesthesia needed to emerge from anesthesia.Balancing this drug and titrating the drug according to the expected stimulus and the person’s response can stabilize blood pressure and heart rate throughout the procedure and allow for faster emergence from anesthesia with minimal pain.
Fentanyl is the most commonly used intrathecal opioid because its lipophilicity allows for a rapid onset (5-10 minutes) and moderate duration (60-120 minutes).Spinal administration of hyperbaric bupivacaine with fentanyl may be the optimal combination. Fentanyl works almost immediately, reducing visceral discomfort and even nausea during surgery.
Fentanyl is sometimes given intrathecally as part of spinal anesthesia, or epidurally for epidural anesthesia and pain relief.Due to fentanyl’s high lipid solubility, its action is more localized than that of morphine, which some clinicians prefer for broader analgesic effects.It is widely used in obstetric anesthesia because of its short time to peak effect (about 5 minutes), rapid termination of effect after a single administration, and relative cardiovascular stability.In obstetrics, dosage must be strictly controlled to prevent substantial transfer from mother to fetus.At high doses, the drug may act on the fetus, causing postpartum respiratory distress.Therefore, shorter-acting drugs such as alfentanil or remifentanil may be more suitable for inducing general anesthesia.