少量のモルヒネ追加により疼痛が軽減したフェンタニル耐性のがん性腹膜炎による腹痛の2症例  [in Japanese] Pain reduction after low-dose morphine in two patients with abdominal pain due to carcinomatous peritonitis tolerant to fentanyl  [in Japanese]

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Abstract

フェンタニル単独で除痛が困難であったがん性腹膜炎による腹痛に対して,少量のモルヒネを追加し,腹痛が著減した2症例を報告する.症例1は15歳の女児で,卵巣癌の腹膜播種による腹痛に対して最初の3カ月間はフェンタニル300μg/日で良好な鎮痛が得られていた.その後,腹痛が増強したので1週間で持続フェンタニルを2,400μg/日まで増量し,フェンタニル100μg/回のレスキューを16回/日使用し,ケタミンを併用したが,腹痛はまったく軽減しなかった.モルヒネ(50 mg/日)の持続静脈内投与を追加した後に,腹痛は著減した.症例2は33歳の女性で,胃癌の腹膜播種による腹痛に対して,フェンタニルの持続投与を2週間で9,600μg/日まで増量し,フェンタニル200μg/回のレスキューを25回/日使用し,ケタミンを併用したが,鎮痛効果不十分であった.モルヒネ(150 mg/日)の持続静脈内投与を追加した後に,腹痛は著減した.2症例では,フェンタニルへの耐性が発現していたと考えられた.

The authors report two patients with abdominal pain due to carcinomatous peritonitis that did not decrease despite large doses of fentanyl but decreased after addition of low-dose morphine. Case 1 was a 15-year-old girl with abdominal pain due to ovarian cancer with peritoneal dissemination. The abdominal pain was controlled by intravenous fentanyl at a dosage of 300 μg/day for the first 3 months; thereafter, the abdominal pain worsened. Continuous intravenous fentanyl ≤ 2400 μg/day with 16 daily rescues of fentanyl 100 μg plus intravenous ketamine did not control the pain. Addition of morphine at a dosage of 50 mg/day to continuous intravenous fentanyl, however, relieved the abdominal pain. Case 2 was a 33-year-old woman with abdominal pain due to gastric cancer with peritoneal dissemination. The abdominal pain was not controlled by continuous intravenous fentanyl ≤ 9600 μg/day with 25 daily rescues of fentanyl 200 μg plus intravenous ketamine. Addition of morphine at a dosage of 150 mg/day to continuous intravenous fentanyl, however, relieved the abdominal pain. We conclude that tolerance to fentanyl may have occurred in these two patients.

Journal

  • Journal of Japan Society of Pain Clinicians

    Journal of Japan Society of Pain Clinicians 15(2), 160-164, 2008-04-25

    Japan Society of Pain Clinicians

References:  11

Cited by:  1

Codes

  • NII Article ID (NAID)
    10024130662
  • NII NACSIS-CAT ID (NCID)
    AN10440947
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13404903
  • NDL Article ID
    9525779
  • NDL Source Classification
    ZS47(科学技術--医学--治療医学・看護学・漢方医学)
  • NDL Call No.
    Z19-B321
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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