Can an experienced clinician answer this?

Question

I understand the pharmacology of morphine and fentanyl (structure, binding sites, differences in mu-, delta-, and kappa- opioid occupancy and potency) so I would like the following question to be answered in the *clinical* context (I'm an RN who works in a Neurosurgical ICU with mainly vented patients):

In your clinical experience, which of the two (morphine or fentanyl) have you found to be the better analgesic with the least potent respiratory depressant action?

(Thank you)

Answer 1

Fentanyl is great if you want quick action - morphine is better for sustained relief. They'll both knock out respiratory drive.

I think fentanyl is a little easier to titrate, and I think it has fewer side effects (itching, histamine release)

For (big) surgery, I use a long acting opiate (usually hydromorphone) as a foundation for pain relief, and then add fentanyl to "fine tune" intra-operatively. Then, when the surgery is over, the hydromorphone is still on board to provide long-acting analgesia.

You might be able to do the same thing in the ICU - a baseline of morphine, and tweak it with fent.

Answer 2

1

Answer 3

Morphine was given to me half an hour before they opened my thorax.
Fentanyl is given to people who used opioids earlier