Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain, a case report

Eur J Pain. 2001;5(3):325-9; discussion 329-31. doi: 10.1053/eujp.2000.0220.

Abstract

Pain partially responsive to opioids can lead to rapid escalating dosages due to tolerance development. In this report the case of a 58-year-old female with neuropathic pain using increasing transdermal (TTS) fentanyl dosages to a maximum dose of 3400 microg/h resulting in fentanyl plasma levels of 173 ng/ml is described. For pain relief an epidural infusion at the level T1-2 with bupivacaine was started. Immediate pain relief was accompanied by short lasting respiratory depression and drowsiness.

Publication types

  • Case Reports

MeSH terms

  • Administration, Cutaneous
  • Analgesia, Epidural / methods
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Anesthetics, Local / pharmacology
  • Breast Neoplasms / complications
  • Bupivacaine / administration & dosage
  • Bupivacaine / adverse effects
  • Carcinoma / complications
  • Chronic Disease
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Tolerance / physiology*
  • Female
  • Fentanyl / administration & dosage*
  • Fentanyl / adverse effects
  • Humans
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / adverse effects
  • Neuralgia / drug therapy*
  • Neuralgia / etiology
  • Neuralgia / physiopathology
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Pain, Intractable / physiopathology
  • Pancoast Syndrome / drug therapy*
  • Pancoast Syndrome / etiology
  • Pancoast Syndrome / physiopathology
  • Treatment Failure

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Morphine
  • Fentanyl
  • Bupivacaine