| Estado de coma que amenaza la vida y quemadura solar en un paciente con fentanil-TTS. Informe de caso |
Life-threatening coma and full-thickness sunburn in a patient treated with transdermal fentanyl patches: a case report.
Sindali K, Sherry K, Sen S, Dheansa B.
Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, United Kingdom. ksindali@gmail.com.
J Med Case Rep. 2012 Jul 26;6(1):220. doi: 10.1186/1752-1947-6-220.
Abstract
INTRODUCTION: Fentanyl transdermal patches have been widely used in the treatment of chronic pain and in palliative care settings since 1991 in cases where prolonged opioid use is often necessary. Transdermal drug delivery is deemed safe and effective with the advantages of delivering a steady dose of the drug and improving patient compliance due to its ease of use. However, intentional and unintentional misuse and overdose using transdermal opioid patches has been widely reported in the literature. CASE PRESENTATION: We describe the case of a 77-year-old Caucasian woman who developed severe opioid toxicity while sun tanning, likely due to altered fentanyl transdermal patch function in a heated environment. As a result of prolonged sun exposure due to an opioid-induced coma she then sustained hyperthermia and severe burns to her abdomen and lower limbs. This inadvertent fentanyl overdose necessitated initial treatment in intensive care and follow on care in a specialist burn unit. CONCLUSION: Patients who are using fentanyl patches and their relatives should be educated about how to use the patch safely. Healthcare practitioners should warn patients about the possibility of overdosing on transdermally delivered drugs if used incorrectly. They should avoid strenuous activities and external heat sources such as warming blankets, hot water bottles, saunas, hot tubs or sunbathing and should seek medical attention if they develop a fever. Additionally, any burns sustained in the context of altered consciousness levels such as in this case with opioid overdose should raise suspicion about a potential deeper burn injury than is usually observed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427044/pdf/1752-1947-6-220.pdf
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| Estudio clínico multicéntrico sobre la eficacia y seguridad del parche matrix de fentanil transdérmico en el manejo de dolor oncológico moderado severo en 474 pacientes chinos |
Multicenter clinical study for evaluation of efficacy and safety of transdermal fentanyl matrix patch in treatment of moderate to severe cancer pain in 474 chinese cancer patients.
Zhu YL, Song GH, Liu DQ, Zhang X, Liu KF, Zang AH, Cheng Y, Cao GC, Liang J, Ma XZ, Ding X, Wang B, Li WL, Hu ZW, Feng G, Huang JJ, Zheng X, Jiao SC, Wu R, Ren J.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100142, China;
Chin J Cancer Res. 2011 Dec;23(4):317-22. doi: 10.1007/s11670-011-0317-7.
Abstract
OBJECTIVE: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have been obtained. This study aimed to assess the efficacy and safety of the new system in Chinese patients with moderate to severe cancer pain. METHODS: A total of 474 patients with moderate to severe cancer pain were enrolled in this study and were treated with the new transdermal fentanyl matrix patch (TDF) up to 2 weeks. All the patients were asked to record pain intensity, side effects, quality of life (QOL), adherence and global satisfaction. The initial dose of fentanyl was 25 μg/h titrated with opioid or according to National Comprehensive Cancer Network (NCCN) guidelines. Transdermal fentanyl was changed every three days. RESULTS: After 2 weeks. The mean pain intensity of the 459 evaluated patients decreased significantly from 5.63±1.26 to 2.03±1.46 (P<0.0001). The total remission rate was 91.29%, of which moderate remission rate 53.16%, obvious remission rate 25.49% and complete remission rate 12.64%. The rate of adverse events was 33.75%, 18.78% of which were moderate and 3.80% were severe. The most frequent adverse events were constipation and nausea. No fatal events were observed. The quality of life was remarkably improved after the treatment (P<0.0001). CONCLUSION: The new TDF is effective and safe in treating patients with moderate to severe cancer pain, and can significantly improve the quality of life.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551305/pdf/cjcr-23-04-317.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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