Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathicischaemic pain in haemodialysis patients: A case series

M. Karanikolas, D. Aretha, P. Kiekkas, G. Monantera, I. Tsolakis, K. S. Filos

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background and objective: Use of opioids is common in perioperative haemodialysis patients because they often suffer from intractable ischaemic or neuropathic lower extremity pain. Intravenous (IV) fentanyl, patient-controlled analgesia (PCA) does not appear to have been evaluated in this setting; hence this study. Methods and results: This is a prospective, single-centre study. IV fentanyl PCA was used for pain control in 16 patients with lower extremity, neuropathicischaemic pain, scheduled for major lower extremity amputation. IV fentanyl PCA was used before and after amputation in eight patients, before but not after amputation in seven patients, and until death in one terminal cancer patient who chose to forgo surgery. Pain intensity was assessed with the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire. Depth of sedation was assessed on a 4-point scale. Ischaemic pain scores were high before fentanyl PCA started, but decreased significantly and remained low with fentanyl PCA use (P < 0·001). Phantom pain scores were low (VAS ≤ 4). Respiratory depression was not a problem in any patient. Conclusions: Concerns about accumulation of active opioid metabolites make provision of adequate analgesia problematic in haemodialysis patients scheduled for amputation, and emergency surgery. Our data on a small patient population suggest that IV fentanyl PCA is safe and effective for severe pain in haemodialysis patients.

Original languageEnglish
Pages (from-to)603-608
Number of pages6
JournalJournal of Clinical Pharmacy and Therapeutics
Volume35
Issue number5
DOIs
StatePublished - Oct 2010

Keywords

  • fentanyl
  • haemodialysis
  • opioids
  • pain
  • patient control analgesia
  • peripheral vascular disease

Fingerprint

Dive into the research topics of 'Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathicischaemic pain in haemodialysis patients: A case series'. Together they form a unique fingerprint.

Cite this