Fentanyl - any pharmacists / anesthesiologist

[Tryingtodobetter82]

Hi,

This is a bit of a strange question, more curiosity than anything else.

I have had two operations recently and both times I was given Fentanyl. It did absolutely nothing, the nurses were genuinely shocked I was still in so much pain. I never got to see the anesthesiologist again so I couldn’t ask him.

all I can find online is abusers can build a tolerance to it.
Am I just really weird that one of these strongest pain killers doesn’t do anything at all to me?

Are you a redhead?

It’s a short-acting opiate so the analgesic effect wears off quickly.

I’m not, I have brown hair. Is there a connection there?

@Contraryjane ive heard that. But it was after I came around. The nurse was putting more and more into my cannula (until she reached the max she was allowed) and she was so shocked that I was still crying in pain 😔

I have EDS and it does nothing for me unfortunately :(

@Newdoggo what is EDS?x

My son has EDS (hypermonility in joints) and paracetamol has zero effect on him (for either temperature or pain) so that must be a thing.

I’m a pharmacist- and yes it’s rare in my experience for an opiate as strong as fentanyl to have no impact. I’ve never come across it. I can see it would put them in a tough position as you can’t then load up on another opiate and risk toxicity.

@DailyEnergyCrisis The got me to eat and gave me an Oxy (which I was terrified of) but it took the pain away in minutes.
they sent me back with oramorph and codine but I stopped taking them as they were having zero effect on me. 😢

Diamorphine and oxy seem to be the only options which work, I’ve had the Diamorphine for sedation, is it also a pain killer?
Is there a different make up to them over Fentanyl?

Sorry for the long response but I’m so curious as to why my body would have no effect from it.

@sunbum ahh I do have a mild form of this.

Do you mean oxycodone?

The thing is, you can’t really say it had no effect on you. You would have had to have gone through the same surgery with no pain relief to compare how effective the pain relief you had was.
It could be possible that your pain levels were reduced, but not as much as you expected.

I had a similar experience with morphine after an operation - they loaded me up with it but it made no discernable difference to the pain I was feeling so they ended up giving me ketamine instead. It was on my notes, so when I had a c-section a couple of years later, they didn't bother with morphine based pain relief and I had something else instead (can't remember what that time) so it was obviously enough of a non-reaction to be noteworthy!

I’m a redhead and struggle with drugs and anaesthetics
After an anaesthetic I am awake within seconds and asking for food, if I haven’t already tried to extubate myself
currently working having taken the max dose of dihydrocodeine and oral morphine, none of which is really touching the pain
The dentist last time did 5 injections just to get me numb for a filling

I have the 'red hair gene'. I had a gall stone removed from my bile duct last year. The surgeon doing the pre-chat told me they would be using fentanyl and propafol(?) as the sedation. I don't remember much about it other than a blue 'patch' being put somewhere on one of the organs? I was watching it on the screen.

I know there's a pharmacist on the thread so they may know - but I was told that they would be using BOTH drugs, not just fentanyl. I was off my face in pain beforehand so I can't remember the reason?

I'm sorry that you went through so much pain, OP, sounds awful.

Isn't diamorphine the same as heroin?

Yes it is but the pharmaceutical name is diamorpine, it's an excellent pain killer. Heroin always has negative connotations which is why its never referred 9 by health professionals..Fentanyl is a synthetic drug, diamorphine is from poppies.

pain is complex and different people need different amounts of drug and different types of drugs for apparently similar conditions. If a moderate dose of a punchy opioid like fentanyl isn't really helping we add in other agents, partly because multimodal analgesia is sensible, but also partly to avoid the inevitable respiratory depression and drowsiness you'd get if you just stuck to the one agent. Different types of pain respond to different analgesic actions in different ways too which might make different drugs more likely to help.

Anaesthetists are used to giving whacking great doses of fentanyl and other opioids and managing the side effects in theatre where it really doesn't matter if someone stops breathing, but outside of theatre clearly that can cause more of a problem so the dosing needs to be more careful. Some people do find they get on better with one drug vs others for post op pain relief (some drugs affect more/different receptor types), but if fentanyl's not working often it's just because the increments prescribed are smaller than you need.

It also isn't just 'abusers' that develop tolerance - anyone on an opioid long term will have a degree of tolerance and need different dosing regimes. DOI: anaesthetist.

Dd is a red head and had to have the maximum dose of fentanyl after surgery last year. She awoke from the anaesthetic in a huge amount of pain and it took them ages to get her pain under control. They said it was because she is ginger.

fentanyl is an analgesic. Propofol is a sedative/anaesthetic that is amnesic but not analgesic. The surgeon most likely won't have had a clue what you were having - it'll have been the anaesthetist you spoke to!

Generally, if all you need is something to make you forget an experience/care less about it then a sedative drug is what's needed. If a procedure would be expected to be painful then you need something that is analgesic too, hence the use of two drugs for lots of things. Propofol has some pretty funky side effects, needs a particular skill set and is not something that should be given by the 'occasional' sedationist (as Michael Jackson's cardiologist proved). It's also is not used in the recovery room for pain relief (which is what it sounds like the OP was describing). HTH.

Do you have hypermobility?

@Soontobe60 thats a really good point. But they say it’s really fast acting and they hadn’t put any in before I woke up. I think they put in 200mcg at 50mcg at a time and the pain never got better at any point 😢😢

@ClaudiusTheGod yes, I didn’t even realise they used it over here

@EducatingArti
yes, it’s the medical name apparently. i keep playing with my mum (ex nurse of 40 years) “at least i know my drug of choice if it comes to it” 😂
she knows I’m just joking.

@MissMoneyFairy could it be because it’s synthetic it doesn’t work on me maybe?