Abstract
We report the results of treatment of breakthrough pain in patients with cancer, who were using transdermal fentanyl and could not take oral medications, using a disposable infuser for patient-controlled analgesia (PCA) with opioids. Intravenous or subcutaneous rescue dose of morphine or fentanyl with ketamine (1-3 mg) was initially begun with 5% of equipotent dose of daily fentanyl delivered through transdermal route. Optimal rescue dose of opioid was determined by pain reduction, sedation, and degree of satisfaction of the patients. We analyzed 16 cancer patients with breakthrough pain who had used transdermal fentanyl 2.5-60 mg/72 hours. The optimal equipotent rescue dose of opioids was 5.8±1.9% (mean±S.D.) of the basal daily fentanyl. We conclude that intravenous opioids with small dose of ketamine given by disposable PCA infuser is effective for the treatment of breakthrough pain in patients with cancer who cannot take medications orally. This modality of treatment improves patients' satisfaction and makes it easier to titrate the optimal rescue dose for breakthrough pain.
