Severe respiratory depression in a patient with gastroparesis while receiving opioids for pain.
OBJECTIVE
To increase awareness of the possibility of severe respiratory depression when oral opioids are used in patients with gastrointestinal motility disorders.


METHODS
A major county hospital affiliated with a university.


METHODS
A patient with severe pain from diabetic muscle necrosis with a history of gastroparesis.


METHODS
Attempted pain control with oral and transdermal opioids.


CONCLUSIONS
Pain control in our patient was attempted using potent oral opioids on two occasions. However, this patient suffered severe respiratory depression after each attempt. Transdermal delivery of fentanyl eventually provided satisfactory pain relief without side effects. We conclude that patients with gastrointestinal motility disorders may be at high risk for side effects of oral opioids due to altered absorption kinetics. Suggestions are made for alternative strategies for opiate delivery in patients with gastrointestinal motility disorders.
Clark
J D
JD
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA. djclark@u.washington.edu
Edwards
T
T
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D018589:Gastroparesis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012120:Respiration Disorders / Q000139:chemically induced*
D000701:Analgesics, Opioid; D005283:Fentanyl