Alfentanil
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Alfentanil Paradoxical reaction in the form of hyperalgesia: case report
A 92-year-old man exhibited paradoxical reaction in the form of hyperalgesia during treatment with alfentanil for abdominal pain. The man, who had dementia, presented with severe abdominal pain and fever. He was eventually diagnosed with perforated acute appendicitis and acute kidney injury, and was therefore hospitalised. He was initially treated with a single dose of SC oxycodone for abdominal pain, to which a good response was noted. Then, he started receiving alfentanil 0.5mg/24 hours (an opioid analgesic) for pain [route not stated] along with midazolam with a syringe driver. On day 2 of hospitalisation, he was alert but disoriented and it was observed that his abdomen became tender even to a light touch. He experienced distress during washes and repositioning. Subsequently, the alfentanil dose was increased to 1mg/24 hours. On day 3 of hospitalisation, he was restless, calling out and pulling his knees to his chest, due to the tender abdomen (sensitive even to a gentle palpation). The alfentanil dose was further increased to 1.5mg/24 hours. On day 4 of hospitalisation, his distress continued and increased even with gentle touch of his limbs and abdomen, suggesting of diffuse allodynia. Based on the clinical deterioration with respect to dose escalation of alfentanil, it was postulated that a paradoxical hyperalgesia was induced by alfentanil. The man’s therapy with alfentanil was therefore stopped. The following day, he was found to be comfortable, settled and alert. He did not experience pain or distress thereafter. His medical condition continued to improve. Ten days later, he was discharged. Virani F, et al. Opioid-induced hyperalgesia from alfentanil. BMJ Supportive and Palliative Care 10: 310-311, No. 3, 19 Aug 2020. Available from: URL: http:// doi.org/10.1136/bmjspcare-2019-001901
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Reactions 17 Oct 2020 No. 1826
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