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Consensus Perioperative Management Best Practices for Patients on Transdermal Fentanyl Patches Undergoing Surgery

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The administration of a transdermal fentanyl patch can be complicated with different pharmacokinetics than other fentanyl preparations.

Recent Findings

The medical condition and baseline opioid requirements must all be carefully considered when dosing a fentanyl patch. An advantage of the fentanyl patch is its ability to bypass the gastrointestinal tract and in many patients, provide effective analgesia with minimal side effects. Fentanyl patches must be carefully administered since morbidity and/or mortality can result from the following: Giving higher doses than a patient needs, combining the medication with potent sedatives, or heating a fentanyl patch. The use of a transdermal fentanyl patch for the treatment of acute postoperative pain is not recommended and any patient undergoing a surgical procedure should have the fentanyl patch removed preoperatively.

Summary

The current manuscript discusses the history of fentanyl and the fentanyl patch, as well as perioperative considerations, contraindications, current clinical efficacy, and clinical adversities related to the transdermal fentanyl patch. Regarding the heating of a transdermal fentanyl patch, which significantly increases blood levels of fentanyl, it is of the utmost importance that the patch be removed prior to surgery.

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Authors and Affiliations

  1. Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA

    Alan David Kaye, Bethany L. Menard & Ken P. Ehrhardt

  2. Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Sonja A. Gennuso, Eva C. Okereke, Sridhar R. Tirumala, Charles J. Fox & Elyse M. Cornett

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  1. Alan David Kaye
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Correspondence to Elyse M. Cornett.

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Conflict of Interest

Bethany L. Menard, Ken P. Ehrhardt, Sonja A. Gennuso, Eva C. Okereke, Sridhar R. Tirumala, Charles J. Fox, and Elyse M. Cornett declare no conflict of interest. Dr. Kaye is on the Speakers Bureau for Depomed, Inc., and Merck.

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Kaye, A.D., Menard, B.L., Ehrhardt, K.P. et al. Consensus Perioperative Management Best Practices for Patients on Transdermal Fentanyl Patches Undergoing Surgery. Curr Pain Headache Rep 23, 50 (2019). https://doi.org/10.1007/s11916-019-0780-2

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