SUBCUTANEOUS FENTANYL INFUSION IN A PATIENT WITH BOWEL OBSTRUCTION AND RENAL-FAILURE

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.