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American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 3, 229-230 (2003)
DOI: 10.1177/104990910302000313

Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice

Iain Lawrie, MB, ChB, MRCGP

Leicestershire Hospice, Leicester, England

Mari Lloyd-Williams, MD, MRCGP, MMedSc, ILTM

Community Studies Unit, University of Liverpool Medical School, Liverpool, England

Esther Waterhouse

Leicestershire Hospice, Leicester, England

Durogesic® (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period, 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia—the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength, in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.

Key Words: pain • opiates • palliative care • analgesia • transdermal fentanyl


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