Lenz K L, Dunlap D S
Department of Pharmacy Practice, Medical University of South Carolina, Charleston 29425, USA.
Ann Pharmacother. 1998 Mar;32(3):316-9. doi: 10.1345/aph.17285.
To describe the use of a continuous fentanyl infusion in an adult cancer patient.
A 66-year-old white woman diagnosed with metastatic pancreatic carcinoma required hospital admission for pain control after receiving five different chemotherapy regimens. Morphine 2 mg/h i.v. was initiated and the dosage was titrated upward to a total of 6613 mg/d by hospital day 16. As hospital supplies of opioids became depleted over a holiday weekend, therapy was changed to a continuous infusion of hydromorphone 70 mg/h on hospital day 17, then changed to a continuous fentanyl infusion beginning with a dosage of 500 micrograms/h. The fentanyl dosage was titrated to 4250 micrograms/h by hospital day 20. She died comfortably on hospital day 22 while receiving this dosage.
Continuous infusions of opioids, particularly morphine and hydromorphone, are frequently used for control of cancer pain and are safe and effective when administered by this route. Transdermal fentanyl has been shown to effectively manage chronic cancer pain, and use of continuous subcutaneous fentanyl has been reported. However, reports of continuous intravenous fentanyl infusion in the cancer pain literature are limited. Our patient achieved good pain control with a continuous infusion of fentanyl 4250 micrograms/h.
Continuous fentanyl infusion should be considered for the treatment of cancer pain in patients requiring high doses who become refractory to other opioids, when other opioids cause intolerable adverse effects, when patients have a true morphine allergy, or when high-dose requirements threaten to deplete existing stock of alternate opioids.
描述在一名成年癌症患者中持续输注芬太尼的应用情况。
一名66岁的白人女性，被诊断为转移性胰腺癌，在接受了五种不同的化疗方案后因疼痛控制需要住院治疗。开始静脉注射吗啡2毫克/小时，到住院第16天时剂量逐渐增加至总计6613毫克/天。由于在一个节假日周末医院的阿片类药物供应耗尽，在住院第17天治疗改为持续输注氢吗啡酮70毫克/小时，然后在住院第18天改为持续输注芬太尼，起始剂量为500微克/小时。到住院第20天时，芬太尼剂量逐渐增加至4250微克/小时。她在接受该剂量治疗时于住院第22天安详离世。
持续输注阿片类药物，尤其是吗啡和氢吗啡酮，常用于控制癌症疼痛，通过这种途径给药是安全有效的。经皮芬太尼已被证明能有效管理慢性癌症疼痛，并且已有持续皮下输注芬太尼的报道。然而，癌症疼痛文献中关于持续静脉输注芬太尼的报道有限。我们的患者通过持续输注4250微克/小时的芬太尼实现了良好的疼痛控制。
对于需要高剂量且对其他阿片类药物产生耐药性、其他阿片类药物引起无法耐受的不良反应、患者存在真正的吗啡过敏，或高剂量需求可能耗尽现有其他阿片类药物库存的癌症疼痛患者，应考虑持续输注芬太尼进行治疗。
