Long-term Continuous Subcutaneous Infusion of Ketoprofen Combined With Morphine: A Safe and Effective Approach to Cancer Pain

Moselli, Nora Maria; Cruto, Mariaenrica; Massucco, Paolo; Savojardo, Maurizio; Debernardi, Felicino

doi:10.1097/ajp.0b013e3181c20221

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…CRI or oral administration in horses with normal gastrointestinal motility. While there are no reports in the veterinary literature, CRI of NSAIDs has been described in human medicine for treatment of fever or pain due to surgery or cancer (Beattie et al ., ; Moselli et al ., ; Grimsby et al ., ). When administered as a CRI in humans, KT has been shown to be safe and effective at providing analgesia and reducing the use of opiates (Burns et al ., ; Myers & Trotman, ).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of ketorolac tromethamine in horses after intravenous, intramuscular, and oral single‐dose administration

Bianco

Constable

Cooper

et al. 2015

Vet Pharm & Therapeutics

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are an integral component of equine analgesia, yet currently available NSAIDs are both limited in their analgesic efficacy and have adverse effects. The NSAID ketorolac tromethamine (KT) is widely used in humans as a potent morphine-sparing analgesic drug but has not been fully evaluated in horses. The purpose of this study was to determine the pharmacokinetic profile of KT in horses after intravenous (i.v.), intramuscular (i.m.), and oral (p.o.) administration. Nine healthy adult horses received a single 0.5-mg/kg dose of KT via each route of administration. Plasma was collected up to 48 h postadministration and analyzed for KT concentration using HPLC/MS/MS. Noncompartmental analysis of i.v. dosage indicated a mean plasma clearance of 8.4 (mL/min)/kg and an estimated mean volume of distribution at steady-state of 0.77 L/kg. Noncompartmental analysis of i.v., i.m., and p.o. dosages indicated mean residence times of 2.0, 2.6, and 7.1 h, respectively. The drug was rapidly absorbed after i.m. and p.o. administration, and mean bioavailability was 71% and 57% for i.m. and p.o. administration, respectively. Adverse effects were not observed after i.v., i.m., and p.o. administration. More studies are needed to evaluate the analgesic and anti-inflammatory properties of KT in horses.

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of ketorolac tromethamine in horses after intravenous, intramuscular, and oral single‐dose administration

Bianco

Constable

Cooper

et al. 2015

Vet Pharm & Therapeutics

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“…With regard to the route of administration, when the oral route is impracticable, continuous subcutaneous infusion (CSI) is considered as an effective, simple and cheap alternative. In a prospective observational open-label study, patients with severe pain receiving more than 240 mg of oral morphine equivalents, or patients who failed adequate trials of other strong opioids were treated with a continuous infusion of CSI of ketoprofen added to CSI of morphine [21]. This group of patients was also compared with a concomitant group of patients treated with a CSI of morphine only, because of existing contraindications to NSAIDs.…”

Section: Nsaidsmentioning

confidence: 99%

The long and winding road of non steroidal antinflammatory drugs and paracetamol in cancer pain management: A critical review

Mercadante

Giarratano

2013

Critical Reviews in Oncology/Hematology

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The aim of this review was to assess the value of NSAIDs and paracetamol in patients with cancer pain to update a previous review performed ten years ago on this topic. The approach was analytic and based on clinical considerations, rather than on raw evidence, which often does not provide useful information in clinical practice. Both published reports from an extensive search of electronic data bases were collected from January 2001 to December 2011. A free-text search method was used including the following words and their combination: "Anti-inflammatory drugs OR paracetamol OR acetaminophen" AND/OR "cancer pain". Any randomized-controlled trial was considered. Thirteen reports fulfitted inclusion criteria in this systematic review. Randomized trials have been performed by using different modalities of intervention. Single drugs added on opioid therapy or during opioid substitution with opioids as rescue drugs through a patient controlled analgesia, were compared with placebo or between them. Five studies regarded paracetamol. Other four studies assessed the efficacy dipyrone, ketorolac, dexketoprofen, and subcutaneous ketoprofen in cancer pain management, mainly on top of an opioid regimen. The role of paracetamol and NSAIDs in the management of cancer pain still remains controversial. The papers published in this last decade were unable to answer the main questions. There is no proof that they should be used to start the treatment and how long they should be administered when opioid treatment is added on top. While paracetamol seems to be devoid of any benefit, particularly if given at usual clinical doses which should be less than 4 g/day, ketorolac seems to provide an additive analgesic effect even in patients receiving different doses of opioids. The main indication from the analysis of these data is that NSAIDs could be given in patients receiving opioids, evaluating their benefit and weight on opioid therapy in individual patients who have a favorable response to justify a prolonged use.

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“…Of the 18 studies considered for inclusion (150)(151)(152)(153)(154)(155)(156)(157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167), 7 studies met the inclusion criteria for methodologic quality assessment (150)(151)(152)(153)(154)(155)(156) with at least 50 participants and at least 3 months of follow-up. Either sample size and/or duration of follow-up were the primary limiting factors for meeting the inclusion criteria established for the review (157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167).…”

Section: Methodologic Quality Assessmentmentioning

confidence: 99%

“…The 7 studies meeting the inclusion criteria for this review (150)(151)(152)(153)(154)(155)(156) varied in their orientation and focus in dealing with opioid therapy in cancer pain. Research issues pertaining to novel opioid delivery systems, additive analgesic effects, multimodal therapy, comparative Table 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

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A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain

Colson

Koyyalagunta²,

Falco

et al. 2011

Pain Phys

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Background: The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. Methods: The comprehensive literature search was conducted for the period 1996 through June 2010. Databases for the search included PubMed, EMBASE, Cochrane Reviews, and clinicaltrails.gov, along with reviews and cross references. Methodologic quality assessment of the observational studies managing chronic cancer pain with opioids was conducted utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. Analysis of evidence included 5 levels of evidence developed by the United States Preventive Services Task Force (USPSTF) ranging from Level I to III with 3 subcategories in Level II. Grading recommendations were based on Guyatt et al’s recommendations with 6 levels: 3 in the strong category and 3 in the weak category. Results: This evaluation is of 18 manuscripts considered for inclusion; 7 manuscripts met the inclusion criteria based on AHRQ quality assessment. Level of evidence for opioid therapy in cancer pain was Level II-3, and recommendations were 1C/strong recommendation based on observational studies, which could change based on future evidence. Conclusion: This systematic review of observational studies indicates Level II3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence. Key words: Chronic pain, cancer pain, non-cancer pain, randomized trials, observational studies, case reports, opioids, effectiveness

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Long-term Continuous Subcutaneous Infusion of Ketoprofen Combined With Morphine: A Safe and Effective Approach to Cancer Pain

Abstract: Ketoprofen CSI in combination with opioids is a feasible, safe, and effective approach to cancer pain.

Cited by 11 publications

References 20 publications

Pharmacokinetics of ketorolac tromethamine in horses after intravenous, intramuscular, and oral single‐dose administration

Pharmacokinetics of ketorolac tromethamine in horses after intravenous, intramuscular, and oral single‐dose administration

The long and winding road of non steroidal antinflammatory drugs and paracetamol in cancer pain management: A critical review

A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain

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