Archive April 2018 XIX, No. 4

Ideas That Work: 5 Ways to Survive the Fentanyl Shortage

Outpatient Surgery Editors


Short Supply
SHORT SUPPLY Many surgical facilities are dealing with an acute shortage of fentanyl.

Track Drug Shortages

Visit the American Society of Health-System Pharmacists ( to see which drugs are in short supply, timelines for delivery of the drugs and alternatives you can use in place of the shortage drugs.

You're not alone if you're having a hard time getting fentanyl. An acute nationwide shortage has sent many facilities scrambling for alternative ways to control surgical pain. Here are some steps you can take to survive the shortage.

1. Ration your fentanyl supply. Use injectable opioids to treat pain, not to sedate patients. One surgery center uses Dilaudid for adults in PACU and reserves fentanyl for pediatric patients. In inhalational cases, some anesthesia providers give morphine at the end of the case for pain control.

2. Load up on different vial sizes. One anesthesia coordinator bought fentanyl 5 mcg and 250 mcg when the 100 mcg was not available. "I know it's more to waste, but it's our only option."

3. Online search strategies. Try searching "ampules" instead of "vials" when ordering online, says Sheldon S. Sones, RPh, FASCP, a pharmacy consultant in Newington, Conn. A glass ampule will give you a different dosage form, but it's the same drug, he says. Similarly, you might try ordering under the trade name, Sublimaze. One administrator was happy to find 20 cc ampules of Sublimaze ("not too expensive for the waste," she says) as well as 1 ml and 2 ml Sufenta (sufentanil).

4. Caution when using alternative drugs. If you consider using other formulations such as meperidine and Dilaudid (hydromorphone), be aware of the risk of an error or adverse outcome when using unfamiliar alternative drugs. Not all injectable opioids are interchangeable for all indications. During a similar shortage in 2010, 2 patients died when IV hydromorphone was administered at the intended dose for morphine.

5. Non-opioid multimodal pain management. In some cases, you can mitigate post-op pain by attacking it before surgery with nerve blocks or non-opioid analgesics. For example, you can give Celecoxib with 975 mg of acetaminophen, says Mr. Sones, who cautions that celecoxib is contraindicated for use in patients allergic to sulfonamides.

— Outpatient Surgery editors


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