Intravenous versus Subcutaneous Morphine Titration in Patients with Persisting Exacerbation of Cancer Pain

Elsner, Frank; Radbruch, Lukas; Loick, Georg; Gaertner, Jan; Sabatowski, Rainer

doi:10.1089/jpm.2005.8.743

Cited by 52 publications

(29 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, if pain is severe, more vigorous dose increments are justifiable, especially if opioid therapy is adjusted and reassessed by an experienced team [2]. Very severe pain should be titrated by intravenous or subcutaneous bolus injections at very short intervals [44]. While such management achieves quick analgesia, it is associated with the risk of delayed toxic effects [2].…”

Section: Non-opioidsmentioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

View full text Add to dashboard Cite

Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).

show abstract

Section: Non-opioidsmentioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

View full text Add to dashboard Cite

show abstract

“…There have been trials comparing IV and SC drug administration with most reporting on drug efficacy and safety [7][8][9][10][11][12][13][14][15][16]. In the study by Moreau et al (2011) [11], patients with relapsed multiple myeloma (MM) were randomised to receive bortezomib either by SC administration or IV infusion.…”

Section: Introductionmentioning

confidence: 99%

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review

Stoner

Harder

Fallowfield

et al. 2014

Patient

118

102

View full text Add to dashboard Cite

show abstract

“…Besides, the combination of paracetamol and tramadol has been used in many studies due to high analgesic efficacy with low adverse effect and its efficacy has been proven (13)(14)(15)(16). Moreover, although sc and iv administration of morphine have similar clinical effect and efficacy (17,18), Stuart-Harris et al (19) reported that morphine-6-glucuronate (M6G) and morphine-3-glucuronate (M3G), which are active metabolites of morphine, occurred in high amounts after iv administration of morphine. Among these active meTurk J Anaesth Reanim 2014; 42: 19-22 (20).…”

Section: Discussionmentioning

confidence: 99%

Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

Deni̇z¹,

Erakgün²,

Sergi̇n³

et al. 2014

Turk J Anesth Reanim

View full text Add to dashboard Cite

Objective: In this study, we evaluated subcutaneous (sc) morphine in combination with multimodal analgesia for postoperative pain control after radical nephrectomy and pyeloplasty with flank incision. Methods:Forty-nine patients under The American Society of Anesthesiologists Physical Status classification (ASA) I-III aged 18-85 years undergoing radical nephrectomy and pyeloplasty with flank incision were included in this prospective, randomised study. The patients were divided into two groups (Group O [n=25] and Group M [n=24]) and received standard general anaesthesia. Tramadol (100 mg) and paracetamol (100 mg) were given intravenously before fascia closure and 20 mL of 0.25% levobupivacaine was injected locally at surgical incisions in all patients. Patients in Group M also received 0.1 mg kg -1 morphine subcutaneously. Patient-controlled analgesia (PCA) with tramadol was used for postoperative pain control in both groups. Postoperative pain scores (VAS), vital parameters, side effects, the need for rescue analgesia during 24 hours postoperatively, and patient satisfaction were recorded.Results: Groups were comparable with respect to demographic data, ASA status, and duration of surgery. There were no significant differences between the groups in postoperative PCA tramadol consumption, rescue analgesia, side effects, or vital parameters. Postoperative pain scores (VAS) in Group M were significantly lower at 30, 45, 60, and 120 minutes compared to Group O (p<0.05). Conclusion:In patients undergoing radical nephrectomy and pyeloplasty with flank incision, subcutaneous morphine in combination with multimodal analgesia decreases early postoperative pain scores compared to multimodal analgesia alone.Key Words: Subcutaneous, morphine, postoperative pain, flank incision Abstract O (n=24). Anaesthesia induction in the patients that did not undergo premedication was performed with intravenous (iv) 0.5 mg atropine, iv 2 mg kg -1 propofol, iv 1 µg kg -1 remifentanil for 30-60 seconds (sec) and iv 0.6 mg kg -1 rocuronium, and maintenance was provided by O 2 , air, and sevoflurane and iv infusion of 0.25 µg kg -1 min -1 remifentanil. Before the closure of fascia after the procedure, sc 0.1 mg kg -1 morphine was administered through the deltoid muscle in the patients in Group M. No additional procedure was performed in the patients in Group O. Then, during the closure of the fascia at the end of surgery, 100 mg tramadol and 1 g/100 mL paracetamol was administered in all patients by slow infusion (not shorter than 20 min.). During skin closure, incision line was infiltrated by 20 mL of 0.25% levobupivacaine. Decurarization was provided by iv 0.5 mg atropine and iv 1.0 mg neostigmine. Postoperative pain was controlled in all patients by patient-controlled analgesia (PCA) (tramadol PCA; 4 amp tramadol 100 mg/100 mL in 0.9% NaCl, bolus 20 mg, lock time 15 min., 4-hour limit: 200 mg). In the postoperative period, iv 1 g/100 mL paracetamol was administered by slow infusion (not shorter than 20 min) within the first 24 hours rep...

show abstract

Intravenous versus Subcutaneous Morphine Titration in Patients with Persisting Exacerbation of Cancer Pain

Abstract: Intravenous and subcutaneous-morphine titration are adequate to antagonize persisting pain exacerbations in cancer pain patients quickly and to adapt the continuous opioid analgesic medication.

Cited by 52 publications

References 12 publications

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review

Evaluation Of Multimodal Approach For Postoperative Pain At The patients Who Underwent Flank Incision In The Urology Operating Room

Contact Info

Product

Resources

About