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Letter
Alfentanil in inpatient palliative medicine: practice survey
  1. Farzana Virani and
  2. Mary Miller
  1. Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
  1. Correspondence to Dr Farzana Virani, Palliative Medicine, Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK; farzana.virani{at}nhs.net

https://doi.org/10.1136/bmjspcare-2021-003070

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    Introduction

    Alfentanil has less than 0.5% renal excretion1 2 and is the opioid of choice in end-stage kidney disease (ESKD). Alfentanil was reported in palliative care practice in 1995, four patients were noted to have a reduction in agitation when alfentanil was administered via continuous subcutaneous infusion (CSCI), suggested explanation was the lack of accumulation of active metabolites. A conversion ratio of 10:1 (diamorphine subcutaneously (SC) to alfentanil SC) was proposed in discussion with anaesthetic colleagues.3 This has been adopted in practice despite a paucity of evidence.1

    We surveyed our practice; whether the 10:1 ratio was being used, and reviewed subsequent dose (SD) titration of CSCIs.

    Methods

    Oxford University Hospitals’ protocol provided the survey standards. This advises prescription of alfentanil in patients with severe ESKD (chronic kidney disease (CKD) stage 4 (Glomerular filtration rate (GFR) 15–30 mL/min) or 5 (GFR<15 mL/min)) and recommends use of a ratio of diamorphine:alfentanil SC of 10:1.

    Patients administered alfentanil via CSCI over a 12-month period, March 2017 to March 2018, were identified. Data were captured from electronic notes and prescription charts, to include: diagnosis, indication for, starting and (SD)s of alfentanil and documentation of opioid toxicity.

    The total amount of opioid used in the 24 hours preceding the initial prescription of …

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    Footnotes

    • Twitter @dr_mary_miller

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.