Subcutaneous fentanyl infusion in a patient with bowel obstruction and renal failure

Sebastiano Mercadante, Marina Caligara, Monica Sapio, Roberto Serretta, Franco Lodi

Research output: Contribution to journalArticlepeer-review


Inoperable bowel obstruction in patients with renal failure is a difficult clinical situation. In the last days of life, an accumulation of morphine metabolites in patients with impaired renal function may cause opioid toxicity, including terminal agitation. The use of an alternative drug may prevent morphine metabolite accumulation in uremic patients. Fentanyl may be an alternative to morphine. It has a large apparent volume of distribution, a short plasma half-life, and extensive biotransformation without active metabolites. A patient with acute renal impairment and bowel obstruction was successfully heated with a subcutaneous continuous infusion of fentanyl (25 μg/hr) and boluses of 12.5 μg for the last 2 days of life, limiting the worsening of the dramatic clinical picture of bowel obstruction combined with renal impairment. No local toxicity was evidenced.

Original languageEnglish
Pages (from-to)241-244
Number of pages4
JournalJournal of Pain and Symptom Management
Issue number4
Publication statusPublished - Apr 1997


  • bowel obstruction
  • Cancer pain
  • fentanyl
  • morphine metabolites
  • renal failure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)


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