Fentanyl Patch (Burns Pain)

How it works

Fentanyl is a strong mu-opioid receptor agonist; the patch provides slow continuous absorption across the skin to maintain steady plasma concentrations.

Prescribing in practice

• Transdermal fentanyl is only for opioid-tolerant patients with stable pain and is unsuitable for acute, unstable, or rapidly changing burns pain because of its slow onset and offset and the risk of fatal respiratory depression.
• Heat — including fever, external warming, and the burn-injured hypermetabolic state — increases absorption and can cause dangerous opioid overdose, so the patch must not be applied near heat or to broken or burned skin.
• A depot persists in the skin after removal, so effects and respiratory depression continue for many hours once the patch is taken off.

Monitoring

Monitor sedation level, respiratory rate, and pain control, with particular vigilance during fever or any external warming.

Counselling the patient

• Apply only to intact, healthy skin and keep heat sources, hot baths, and electric blankets away from the patch.
• Tell the team about excessive drowsiness or slow breathing, and dispose of used patches safely as they still contain drug.

Evidence & guidelines

Transdermal fentanyl is established for stable chronic severe pain; the MHRA has warned of the risk of fatal overdose from accidental exposure and heat-increased absorption.