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.
Copyright 2001 European Federation of Chapters of the International Association for the study of Pain.
MeSH terms
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Administration, Cutaneous
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Analgesia, Epidural / methods
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Analgesics, Opioid / administration & dosage*
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Analgesics, Opioid / adverse effects
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Anesthetics, Local / pharmacology
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Breast Neoplasms / complications
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Bupivacaine / administration & dosage
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Bupivacaine / adverse effects
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Carcinoma / complications
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Chronic Disease
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Dose-Response Relationship, Drug
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Drug Administration Schedule
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Drug Tolerance / physiology*
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Female
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Fentanyl / administration & dosage*
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Fentanyl / adverse effects
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Humans
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Middle Aged
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Morphine / administration & dosage
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Morphine / adverse effects
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Neuralgia / drug therapy*
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Neuralgia / etiology
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Neuralgia / physiopathology
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Pain, Intractable / drug therapy*
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Pain, Intractable / etiology
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Pain, Intractable / physiopathology
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Pancoast Syndrome / drug therapy*
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Pancoast Syndrome / etiology
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Pancoast Syndrome / physiopathology
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Treatment Failure
Substances
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Analgesics, Opioid
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Anesthetics, Local
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Morphine
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Fentanyl
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Bupivacaine