Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
HIDALGO, J. J.; FREIXENET, N.; LARA, R. y LIGORIF, C.. Neonatal withdrawal syndrome after the use of transdermal fentanyl during pregnancy. Rev. Soc. Esp. Dolor [online]. 2006, vol.13, n.2, pp.103-107. ISSN 1134-8046.
Fentanyl is a synthetic opioid one hundred times more potent than morphine. Its pharmacologic profile makes it a suitable drug for transdermal delivery in patients with severe oncological and non-oncological chronic pain. So far, only one case of neonatal opioid withdrawal syndrome following the use of transdermal fentanyl in a pregnant patient has been reported. A 35 year old patient in her 23rd week of pregnancy presenting severe lumbar pain (VAS 10) irradiated to lower limbs, as a consequence of paraplegia following surgery for scoliosis at the age of 16 and re-intervention for stabilisation arthrodesis at the age of 32, developed an acute episode of pain in the 20th week of pregnancy. Therapy with paracetamol, metamizol, ketorolac, pethidine and morphine chloride was ineffective, and pain was eventually controlled with fentanyl 50 mcg/h plus oral morphine sulphate 5-10 mg for breakthrough pain; this therapy was maintained for the remaining of the pregnancy. Early delivery took place at the 34th week and the newborn showed a syndrome suggestive of withdrawal in the first 24 hours of life. The baby was admitted to the neonatal intensive care unit, remaining intubated for six days and requiring decreasing doses of morphine chloride until discharge in the 18th day. Psychomotor development during her first six months of life was normal. Her mother´s opioid requirements were progressively reduced and were eventually interrupted, without any pain relapse. Neonatal opioid withdrawal syndrome can occur following prolonged administration of opioids in pregnant women. Its symptoms in the first 24-48 hours of life are neurological (tremor, irritability, hypertonicity, convulsions, discoordination), autonomous (fever, sweating) digestive (diarrhea, vomiting) respiratory (hypoventilation, taquipnea) poor weight gain and dehydration. Opioids, neuroleptics, benzodiazepines, barbiturates and alfa-2 agonists can be used for its treatment. The syndrome has been reported in the new-borns of pregnant women consuming heroin or methadone, but not after prolonged treatments with fentanyl. An unknown effect of this frequent therapy for chronic severe pain is reported. Although further research is required, fentanyl can be regarded as a last choice treatment for severe pain in pregnant women when first and second WHO analgesic ladder drugs are not effective.
Palabras clave : Transdermal fentanyl; pregnancy; neonatal withdrawal syndrome.