S. Mercadante et al., SUBCUTANEOUS FENTANYL INFUSION IN A PATIENT WITH BOWEL OBSTRUCTION AND RENAL-FAILURE, Journal of pain and symptom management, 13(4), 1997, pp. 241-244
Inoperable bowel obstruction in patients with renal failure is a diffi
cult clinical situation. In the last days of life, an accumulation of
morphine metabolites in patients with impaired renal function may caus
e opioid toxicity, including terminal agitation. The use of an alterna
tive drug may prevent morphine metabolite accumulation in uremic patie
nts Fentanyl may be an alternative to morphine. It has a large apparen
t volume of distribution, a short plasma half-life, and extensive biot
ransformation without active metabolites. A patient with acute renal i
mpairment and bowel obstruction was successfully treated with a subcut
aneous continuous infusion of fentanyl (25 mu g/hr) and boluses of 12.
5 mu g for the last 2 days of life, limiting the worsening of the dram
atic clinical picture of bowel obstruction combined with renal impairm
ent. No local toxicity was evidenced. (C) S. Mercadante, 1997.