Fentanyl (Transdermal)

INTRODUCTION

Indications

Moderate-to-severe chronic pain requiring continuous opioid analgesic therapy for an extended time at a dose of 25 mcg/hr or more of the transdermal system. Transdermal fentanyl is not recommended for the control of postoperative, mild, or intermittent pain, nor should it be used for short-term pain relief.

Action

Binds to opiate receptors in the CNS, altering the response to and perception of pain. Therapeutic Effects: Decrease in severity of chronic pain.

Adverse Reactions/Side Effects

CNS: confusion, sedation, weakness, dizziness, restlessness. Resp: APNEA, bronchoconstriction, laryngospasm, respiratory depression. CV: bradycardia. GI: anorexia, constipation, dry mouth, nausea, vomiting. Derm: sweating, erythema. Local: application site reactions. MS: skeletal and thoracic muscle rigidity. Misc: physical dependence, psychologic dependence.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess respiration, and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Apnea or excessive respiratory depression requires emergency care.

• Monitor signs of laryngeal spasm and bronchospasm, including tightness in the throat and chest, wheezing, cough, and severe shortness of breath. Notify physician or nursing staff immediately if these reactions occur.

• Be alert for excessive sedation or changes in mood and behavior (confusion, restlessness). Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

• Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for residual muscle rigidity and decreased thoracic and limb movements. Report a prolonged or sustained increase in muscle tone.

• Monitor patch application site for pain, swelling, and irritation. Report prolonged or excessive application site reactions to the physician.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

• Avoid contact with the transdermal application site, and do not ...