Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction

Conno, F. De; Caraceni, Augusto; Zecca, Ernesto; Spoldi, E.; Ventafridda, Vittorio

doi:10.1016/0885-3924(91)90005-o

Cited by 80 publications

(35 citation statements)

References 6 publications

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“…Several authors have confirmed the efficacy of this approach, and it is successfully used by palliative care centres throughout the world in both in-patients and out-patients [8,19,20,55,56,57,58,59,60,61,62,63,64]. The drugs of choice vary to a certain extent between countries and different centres, based on clinical experience, drug availability, cost and fashion.…”

Section: Pharmacological Treatmentmentioning

confidence: 87%

Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer

Ripamonti¹,

Twycross

Baines³

et al. 2001

Supportive Care in Cancer

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280

183

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The paper highlights a series of questions that doctors need to consider when faced with end-stage cancer patients with bowel obstruction: Is the patient fit for surgery? Is there a place for stenting? Is it necessary to use a venting nasogastric tube (NGT) in inoperable patients? What drugs are indicated for symptom control, what is the proper route for their administration and which can be administered in association? When should a venting gastrostomy be considered? What is the role of total parenteral nutrition (TPN) and parenteral hydration (PH)? A working group was established to review issues relating to bowel obstruction in end-stage cancer and to make recommendations for management. A steering group was established by the (multidisciplinary) Board of Directors of the European Association for Palliative Care (EAPC) to select members of the expert panel, who were required to have specific clinical and research interests relating to the topic and to have published significant papers on advanced cancer patients in the last 5 years, or to have particular clinical expertise that is recognised internationally. The final constitution of this group was approved by the Board of the EAPC. This Working Group was made up of English, French and Italian physicians involved in the field of palliative care for advanced and terminal cancer patients; and of English, American and Italian surgeons who also specialized in artificial nutrition (Dr. Bozzetti) and a professor of health economics. We applied a systematic review methodology that showed the relative lack of RCTs in this area and the importance of retrospective and clinical reports from different authors in different countries. The brief was to review published data but also to provide clinical opinion where data were lacking. The recommendations reflect specialist clinical practice in the countries represented. Each member of the group was allocated a specific question and briefed to review the literature and produce a position paper on the indications, advantages and disadvantages of each symptomatic treatment. The position papers were circulated and then debated at a meeting held in Athens and attended by all panel members. The group reviewed all the available data, discussed the evidence and discussed what practical recommendations could be derived from it. An initial outline of the results of the review and recommendations was produced. Where there were gaps in the evidence, consensus was achieved by debate. Only unanimous conclusions have been incorporated. Subsequently the recommendations were drawn together by Carla Ripamonti (Chairperson) and Robert Twycross (Co-Chair) and refined with input from all panel members. The recommendations have been endorsed by the Board of Directors of the EAPC. It was concluded that surgery should not be undertaken routinely in patients with poor prognostic criteria, such as intra-abdominal carcinomatosis, poor performance status and massive ascites. A nasogastric tube should be used only as a temporary measure. Medical measure...

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Section: Pharmacological Treatmentmentioning

confidence: 87%

Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer

Ripamonti¹,

Twycross

Baines³

et al. 2001

Supportive Care in Cancer

Self Cite

280

183

View full text Add to dashboard Cite

show abstract

“…Two small series demonstrated that a continuous infusion of hyoscine butylbromide (scopolamine) at a dose of 60 mg daily can control symptoms from nonoperable malignant bowel obstruction, including pain [137,139]. Glycopyrrolate (Robinul ® ; First Horizon Pharmaceutical Corp.; Roswell, GA) has a pharmacological profile similar to that of hyoscine butylbromide, but may produce fewer side effects because of a relatively low penetration through the blood-brain barrier; this drug, however, has not been systematically evaluated in a population with symptomatic bowel obstruction.…”

Section: Anticholinergic Drugsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, α α 2 -adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions. The Oncologist 2004;9:571-591

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“…A prolonged experience over the last 15 years and three randomized trials support its superiority in terms of reduction of gastrointestinal secretions [6][7][8][9] and number of daily episodes of vomiting and intensity of nausea [7,10]. On the other hand, anticholinergics inhibit muscarinic receptors at the smooth muscle and intestinal mucosal cells, and block the visceral ganglionic neural transmission, resulting in a decrease of intestinal secretions but also of peristalsis [11]; their antispasmodic effect has converted anticholinergics in a referent for treating colicky pain. Because of their alternative mechanism of action, anticholinergics could provide additional benefits to octreotide, in terms of percentage of resolution and efficacy in palliation.…”

Section: Introductionmentioning

confidence: 99%