1. What do we do if we find a fentanyl patch has fallen off?
If you have a patch-checking chart, see when it was last observed in place. If it was still on the patient’s skin up to 12 hours ago, apply a new patch as the levels will not have fallen too far. Monitor the patient and offer prn doses until the plasma levels have re-established themselves. If you are unsure how long the patch has been detached, it might be safer to re-titrate the patient’s pain using immediate-release opioids. Use the local conversion tables to select the appropriate strong opioid dose and the patient’s drug history to select the appropriate opioid.
2. How to change from patches back to oral opioids:
When do we give the first dose when changing a patient from a buprenorphine patch to oral modified-release oral opioids?
It takes about 24 hours for the levels of opioid to decrease so it should not be necessary to give the first dose of a long-acting opioid until 24 hours post-removal. Consider using a dose which is 50% of the final equivalent dose over the next 24 hours and increase on the third day to the target dose. Monitor the patient as they may need additional p.r.n. doses of immediate-release opioids during the crossover period.
3. Can we got hold of Lidocaine 2% in Lutrol gel?
Yes, Ashtons can obtain this although there is a three–five-day lead time as it is manufactured as a special product and has to be ordered in. Lutrol is a thermoreversible gel which is liquid at fridge temperature but sets at body temperature, so can stay in place on moist skin and wounds to deliver. It can be very soothing as it enables delivery of local analgesia to areas which are usually difficult to manage. For example, it is often used for painful wounds and fungating skin tumours in the vulval area. It is applied at dressing changes once or twice a day and is removed by gentle rinsing with warm water. We can also provide you with an information leaflet – please ask your visiting pharmacist.
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