title: Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain, a case report.
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.
authors.affiliation: Pain Clinic, Department of Anaesthesiology, University Hospital Nijmegen, 6500 HB Nijmegen, the Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: Bleeker
authors.forename: R C
authors.initials: RC
authors.lastname: Bremer
authors.forename: D A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: R T
authors.initials: RT
authors.lastname: van Dongen
authors.forename: B J
authors.initials: BJ
authors.lastname: Crul
mesh_terms: D000279:Administration, Cutaneous; D015360:Analgesia, Epidural / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000494:pharmacology; D001943:Breast Neoplasms / Q000150:complications; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002277:Carcinoma / Q000150:complications; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004361:Drug Tolerance / Q000502:physiology*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010178:Pancoast Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D017211:Treatment Failure
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine