Abstract
Demand basis over a 24-h period. The amount of fentanyl administered was then used as a guideline for selecting a suitable transdermal therapeutic system (TTS) on the 2nd day, which remained in place for 3 days. The size of 2nd TTS, being used from day 5 to 7, was adjusted according to the amount of supplementary intravenous fentanyl doses on day 3. From day 4 to 7 intravenous fentanyl was stopped, and subcutaneous morphine was made available as a rescue medication. A standardized adjuvant medication was allowed. Pain intensity, pain relief, quality of sleep, mood, general state of health, activity, mobility, rescue morphine consumption and side effects were assessed using a diary after baseline pain and symptoms were recorded. Vital functions were monitored and fentanyl plasma levels were measured daily in 15 patients. The use of TTS fentanyl in combination with initial dose titration using PCA gave rapid and statistically significant pain relief. Patient compliance and acceptance were excellent. In the absence of severe side effects the main complaints were dryness of the mouth and constipation. Increasing pain intensity and increasing supplementary morphine requirements as well as decreasing plasma fentanyl levels on day 7 may indicate that conversion ratios from intravenous to transdermal administration should be increased or that TTS should be changed earlier. Special indications for this combination may be in patients with dysphagia or vomiting, where pain management could be facilitated. ∗Correspondence to: Dr. Detlev Zech, Pain Clinic, Department of Anesthesiology and Operative Intensive Care, University of Cologne. Joseph-Stelzmann Strasse 9, DW-5000 Cologne 41, Germany. Tel.: (221) 478-4884; FAX: (221) 478-6093. (Received 2 October 1991; revised 17 February 1992; accepted 21 February 1992.) © Lippincott-Raven Publishers....