title: [Opioid combination of transdermal fentanyl and oral oxycodone for pain in a patient with giant-cell tumor of the sacrum].
abstract: We describe successful pain control in a patient suffering from severe pain, using an opioid combination of transdermal fentanyl and oral oxycodone. A woman in her 40s with a giant-cell tumor of the sacrum suffered from refractory 4-5/5 pain on the Wong-Baker faces pain rating scale in her sacrum, feet and legs. Despite administration of fentanyl (2,520 microg day(-1)), she could not sleep in the supine position due to pain and dysesthesia. We gradually changed her medication from transdermal fentanyl to oral oxycodone. However, the patient complained of constant drowsiness after the complete switch to oral oxycodone (120 mg x day(-1)). Hence, we reduced the oral oxycodone dose and began a combination of transdermal fentanyl and oral oxycodone in addition to increasing doses of pregabalin. With the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) her pain decreased to 1-3/5 on the faces pain rating scale. Our experience suggests that an opioid combination may provide favorable pain control in patients with severe pain, while minimizing the side effects of each drug.
authors.affiliation: Department of Anesthesiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshitake
authors.affiliation: Department of Anesthesiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Anesthesiology, Kumamoto University Hospital, Kumamoto 860-8556.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Susaki
authors.affiliation: Department of Anesthesiology, Kumamoto Regional Medical Center, Kumamoto 860-0811.
authors.forename: Eiji
authors.initials: E
authors.lastname: Abe
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000150:complications*; D004334:Drug Administration Schedule; D004351:Drug Resistance; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D018212:Giant Cell Tumor of Bone / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology*; D010166:Palliative Care; D012447:Sacrum; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone; D005283:Fentanyl