Lehr V T, Renaud E A
Department of Pharmaceutical Services, Hutzel Hospital, Detroit, MI 48201.
Ann Pharmacother. 1993 May;27(5):575-8. doi: 10.1177/106002809302700508.
To report a case of high transdermal fentanyl dosage requirements in a patient with chronic cancer pain.
Clinical studies, review articles, and relevant laboratory information.
A 42-year-old woman with cervical cancer was admitted for control of her pain. Her outpatient analgesic regimen was a continuous intravenous infusion of morphine sulfate (MS) via an ambulatory infusion device. Upon admission, supplemental doses of intravenous MS were administered in an effort to eliminate the pain. Transdermal fentanyl therapy was initiated on hospital day 1 at 100 micrograms/h and the MS continuous intravenous infusion dosage was increased. Over the next four days, the patient experienced episodes of inadequate pain control and the transdermal fentanyl dosage was increased in increments of 100 micrograms/h. On hospital day 4 the MS continuous infusion was converted to patient-controlled analgesia (PCA). The patient reported acceptable pain control with a regimen of transdermal fentanyl 500 micrograms/h and MS via PCA and she was discharged home on hospital day 7.
This patient's high transdermal fentanyl dosage requirement was related to disease progression. She experienced an acute pain episode that may have been effectively managed by increasing the dosage of her continuous intravenous MS infusion.
报告一例慢性癌痛患者透皮芬太尼剂量需求较高的病例。
临床研究、综述文章及相关实验室信息。
一名42岁宫颈癌女性因疼痛控制入院。其门诊镇痛方案为通过便携式输液装置持续静脉输注硫酸吗啡（MS）。入院后，为消除疼痛给予静脉补充MS剂量。入院第1天开始透皮芬太尼治疗，初始剂量为100微克/小时，并增加MS持续静脉输注剂量。在接下来的四天里，患者出现疼痛控制不佳的情况，透皮芬太尼剂量以100微克/小时的增量增加。入院第4天，MS持续输注改为患者自控镇痛（PCA）。患者报告使用500微克/小时透皮芬太尼和PCA形式的MS方案时疼痛控制可接受，于入院第7天出院回家。
该患者对透皮芬太尼的高剂量需求与疾病进展有关。她经历了一次急性疼痛发作，通过增加持续静脉输注MS的剂量可能有效控制。
