Inefficacy of high‐dose transdermal fentanyl in a patient with neuropathic pain a case report

Abstract
Pain partially responsive to opioids can lead to rapid escalating dosages due to tolerance development. In this report the case of a 58‐year‐old female with neuropathic pain using increasing transdermal (TTS) fentanyl dosages to a maximum dose of 3400 μg/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 short lasting respiratory depression and drowsiness.