Inefficacy of high-dose transdermal fentanyl in a patient with neuropathicpain, a case report

Pain partially responsive to opioids can lead to rapid escalating dosages d ue to tolerance development. In this report the case of a 58-year-old femal e with neuropathic pain using increasing transdermal (TTS) fentanyl dosages to a maximum dose of 3400 mug/h resulting in fentanyl plasma levels of 173 ng/ml is described. For pain relief an epidural infusion at the level T1-2 with bupivacaine was started. Immediate pain relief was accompanied by sho rt lasting respiratory depression and drowsiness. (C) 2001 European Federat ion of Chapters of the International Association for the study of Pain.