Fentanyl

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Various toxicities: case report A 39-year-old woman developed mild drowsiness fluctuating to almost a comatose state, moderately severe itching, constipation and nausea during treatment with fentanyl for severe upper abdominal pain due to metastasis of breast cancer in her spleen and liver [durations of treatments to reactions onsets not stated]. The woman was a terminally ill lady with metastatic breast cancer and orthopnea. She presented with moderately severe upper abdominal pain, which started about 4 months before due to metastasis in her spleen and liver. Initially, the pain was well controlled with a transdermal fentanyl patch. Later, despite receiving a high dose of transdermal fentanyl patch 200.µg/hour and superadded frequent sublingual fentanyl 100µg [frequency not stated], her pain was not well controlled. However, she developed mild drowsiness fluctuating to almost a comatose state, moderately severe itching, constipation and nausea. She was able to walk a few steps with support and was continent of stool and urine. As per her oncologist, her life expectancy was less than 2 months. Upon further examinations, she was found to have massive hepatosplenomegaly and metastasis in the long bones. Hence, for relieving severe pain, IV BardPort catheter was used to administer opioid intrathecally. She was then administered preservative-free morphine and fentanyl. Later, she was given intrathecal preservative-free morphine and sublingual fentanyl for breakthrough pain. The woman’s pain was well controlled and fentanyl-induced side effects were reduced with morphine in the following days. She died peacefully in the presence of her relative on 18th day after the insertion of the intrathecal catheter [exact cause of death not stated]. Anwari JS, et al. Use of an intravenous port catheter for the delivery of intrathecal morphine in a terminally ill cancer patient with pain. Neurosciences 25: 399-402, No. 5, Oct 2020. Available from: URL: http://doi.org/10.17712/nsj.2020.5.20200009 803516917

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Reactions 21 Nov 2020 No. 1831