[Opioid combination of transdermal fentanyl and oral oxycodone for pain in a patient with giant-cell tumor of the sacrum].

Abstract

We describe successful pain control in a patient suffering from severe pain, using an opioid combination of transdermal fentanyl and oral oxycodone. A woman in her 40s with a giant-cell tumor of the sacrum suffered from refractory 4-5/5 pain on the Wong-Baker faces pain rating scale in her sacrum, feet and legs. Despite administration of fentanyl (2,520 microg day(-1)), she could not sleep in the supine position due to pain and dysesthesia. We gradually changed her medication from transdermal fentanyl to oral oxycodone. However, the patient complained of constant drowsiness after the complete switch to oral oxycodone (120 mg x day(-1)). Hence, we reduced the oral oxycodone dose and began a combination of transdermal fentanyl and oral oxycodone in addition to increasing doses of pregabalin. With the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) her pain decreased to 1-3/5 on the faces pain rating scale. Our experience suggests that an opioid combination may provide favorable pain control in patients with severe pain, while minimizing the side effects of each drug.

• Authors: Atsushi Yoshitake, Tatsuo Yamamoto, Sachiko Susaki, Eiji Abe
• Journal: Masui. The Japanese journal of anesthesiology (Masui) Vol. 63 Issue 2 Pg. 199-202 (Feb 2014) ISSN: 0021-4892 [Print] Japan
• PMID: 24601119 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Analgesics, Opioid
• Oxycodone
• Fentanyl

Topics

• Administration, Cutaneous
• Administration, Oral
• Adult
• Analgesics, Opioid (administration & dosage)
• Bone Neoplasms (complications)
• Drug Administration Schedule
• Drug Resistance
• Drug Substitution
• Drug Therapy, Combination
• Female
• Fentanyl (administration & dosage, adverse effects)
• Giant Cell Tumor of Bone (complications)
• Humans
• Middle Aged
• Oxycodone (administration & dosage)
• Pain, Intractable (drug therapy, etiology)
• Palliative Care
• Sacrum
• Severity of Illness Index