A 64-year-old male, diabetic and hypertensive.
She has severe chronic kidney disease (stage 5 with GFR 11 ml/min/1.73 m2).
She was scheduled for right total hip arthroplasty due to severe thigh osteoarthritis.
The patient underwent hemodialysis the day before surgery, with a "dry" weight of 69 kg. At 9:20 a.m. spinal anesthesia was performed with a 2.5 ml sprotte-type needle (Pajunk® 2.5 mg).
At 10:00 a.m., a fentanyl patch 25 μg/h (transdermal therapeutic system -TTS) is placed.
The surgery was uneventful.
Upon arrival to the post-anesthetic recovery unit (PCU) (12:30 a.m.), an infusion of 6 grams of metamizole is started in 24 hours (500 ml of saline at a rate of 21 mL).
The patient is included in the acute postoperative pain unit (ACU) maintaining the fentanyl patch 48 hours and recovering pain with transmucosal oral fentanyl 200 μg (maximum every 4 hours with one dose).
At 16:00, the patient was discharged to the hospital with a score of 2 on the visual analogue scale (VAS).
At 22:00, due to a peak of pain, a dose of oral transmucosal fentanyl is administered within 15 minutes.
Twelve hours after removal of the patch (60 hours after surgery) another peak of pain occurs, requiring a second oral fentanyl.
VAS on days 2 and 3 was 0.
This was the third day, when the patient reported nausea that resolved with ondansetron 4 mg IV.
During her stay at the UDA, she did not present vomiting or pruritus or constipation. Sleep quality and night rest were good.
