Abstract
We report a patient who received high-dose transdermal fentanyl to relieve cancer pain. A 56-year-old man with rectal cancer was referred to our pain center because of uncontrolled cancer pain. He had received slow-release morphine 150 mg/day and transdermal fentanyl at a rate of 25 μg/hr. Since the patient had severe constipation and the pain was not controlled, morphine was discontinued and the dose of transdermal fentanyl increased. Addition of intravenous lidocaine and amitriptyline was not effective to control the pain. Intrathecal phenol and lumbar epidural blocks transiently relieved the pain. As the pain worsened with the growth of the tumor, transdermal fentanyl was increased at a rate ≤ 650 μg/hr. The pain was controlled to around 4 of 10 on a numerical score of pain. He was alert and no apparent respiratory depression was noted until his death, which occurred 7 months after admission. Fentanyl concentration in the blood was 9.8, 21.6, and 22.0 ng/ml when the patient received transdermal dosing at 200, 500, and 650 μg/hr, respectively.
