Rapid titration of opiate doses via patient-controlled intravenous analgesia for patients with severe cancer pain

Abstract

This study was to investigate the feasibility and safety of patient-controlled intravenous analgesia for opiate titration in patients with severe cancer. Eligible patients with cancer pain were randomly divided into two groups, which were titrated with a subcutaneous injection of morphine and patient-controlled intravenous analgesia, respectively. The time required for patients to begin titration to reach visual analog scale score ⩽ 3, the adverse reactions during titration, the time spent by nurses in titrating each patient, and the time to complete the titration with a delayed-release dosage form analgesic effect and adverse reaction. The mean titration time of patient-controlled intravenous analgesia group (1.09 ± 0.82 vs 2.97 ± 1.98) and morphine dosage (18.78 ± 12.32 vs 13.23 ± 8.07) were significantly lower than those in the subcutaneous group (P < 0.05). The incidences of nausea, vomiting, pruritus, urinary retention, and sedation in the subcutaneous injection group were significantly lower than those in the subcutaneous injection group (P < 0.05). The assessment times of the two groups (10.19 ± 3.72 vs 10.25 ± 4.88) were similar (P > 0.05). However, the time required for subcutaneous injection in patients under patient-controlled intravenous analgesia was significantly lower than that in the subcutaneous injection group (36.36 ± 12.15 vs 132.36 ± 32.79), which was statistically significant (P < 0.05). After the titration, the controlled release opioid was used to treat cancer pain. The visual analog scale score of the patientcontrolled intravenous analgesia group was significantly lower than that of the subcutaneous group (2.44 ± 1.37 vs 2.73 ± 0.91) at 7 days after treatment in the subcutaneous group (1.05 ± 0.30 vs 2.45 ± 1.29; P < 0.05). Patient-controlled intravenous analgesia technique can effectively and quickly complete the titration of cancer pain treatment with less occupational care resources and is better than the subcutaneous injection titration.

A systematic review of subcutaneous versus intramuscular or intravenous routes of opioid administration on pain outcomes in cancer and post-surgical clinical populations – challenging current assumptions in palliative care practice

“…13 The mean (SD) number of daily pain outbreaks was also lower in the patient-controlled IV analgesia group than that of the SC injection of morphine group, and this was statistically significant, p < 0.05. 13…”

“…Following controlled-release morphine titration after 7 days, the mean (SD) VAS score was significantly lower in the patient-controlled IV analgesia group than that in the SC morphine injection group. 13 The mean (SD) number of daily pain outbreaks was also lower in the patient-controlled IV analgesia group than that of the SC injection of morphine group, and this was statistically significant, p < 0.05. 13…”

“…In cancer patients, Tian et al 13 found systemic adverse reactions such as nausea, vomiting, pruritus, urinary retention and sedation were significantly lower in the IV PCA group ( p < 0.05) than in the SC group.…”

“…9,11,12,14–17 However, two papers demonstrated differences between routes of administration, one in post-surgical patients 10 and the other in cancer pain. 13…”

“…Tian et al 13 found a significant improvement in pain scores at 1 week in cancer patients using morphine titrated via IV patient-controlled analgesia (PCA) group, compared to SC boluses. IV PCA was also found to be a quicker way to titrate morphine to treat cancer pain.…”