The sterility of fentanyl vials

There is a perception by some anaesthetists that fentanyl vials contained in their blister package are sterile. As a result it is common practice in some hospitals, to place the fentanyl vial directly on to the sterile area when performing neuroaxial blockade. We contacted one manufacturer, Martindale Pharmaceuticals, whose official reply was ‘… the sealed glass ampoules… are processed and packed in general environment before being placed in the plastic blisters. These blisters are not sterile and the ampoule exterior is not claimed to be sterile’. We feel it is important to emphasise the possible infective complications of this practice and urge anaesthetists to remove the drug by needle and syringe in a sterile fashion.