Daily application of transdermal fentanyl patches in patients receiving hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) is a treatment for a variety of conditions, particularly nonhealing wounds. The treatment requires the inhalation of pure oxygen in a sealed chamber that is pressurized to 1.5 to 3 times that of normal atmospheric pressure. HBOT safety protocols require all transdermal products to be removed prior to entrance into the hyperbaric chamber, and many institutional policies state that removed patches are not to be reapplied. Limited data are available regarding the use of transdermal fentanyl patches in patients undergoing HBOT. For such patients, the patch would need to be changed on a daily basis. Although the recommended dosing interval is 72 hours, many references discuss the use of 48-hour intervals in select patients, and no published reference recommends dosing intervals shorter than 48 hours. The authors evaluated the clinical safety and efficacy parameters for two patients receiving daily application of transdermal fentanyl while receiving HBOT. Patient 1 was a 47-year-old female with diabetes mellitus, sepsis, and left foot wound with toe necrosis. Complicating her management was the presence of chronic pain syndrome secondary to fibromyalgia. Patient 2 was a 70-year-old female with paralysis secondary to spinal fracture who presented with a stage IV sacral pressure ulcer, who was later diagnosed with osteomyelitis. Both patients were successfully managed with daily application of fentanyl transdermal patch.