Moulin D E, Kreeft J H, Murray-Parsons N, Bouquillon A I
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Lancet. 1991 Feb 23;337(8739):465-8. doi: 10.1016/0140-6736(91)93401-t.
To compare the safety and efficacy of subcutaneous and intravenous infusion of opioid analgesics, a randomised, double-blind, crossover trial was carried out in inpatients. 15 patients with severe cancer pain received two 48 h infusions of hydromorphone--one subcutaneously and one intravenously in randomly allocated order. The study was made double-blind by the use of two infusion pumps throughout; during the active subcutaneous infusion the intravenous pump delivered saline and vice versa. Serial measurements of pain intensity, pain relief, mood, and sedation by means of visual analogue scales showed no clinically or statistically significant difference between the two infusion routes. Side-effects were slight, and the mean number of morphine injections for breakthrough pain did not differ significantly between the routes (4.8 [SD 4.5] for intravenous vs 5.3 [5.6] for subcutaneous). Plasma hydromorphone concentrations measured at 24 h and 48 h of infusion showed stable steady-state pharmacokinetics; the mean bioavailability from subcutaneous infusion was 78% of that with intravenous infusion. Because of the simplicity, technical advantages, and cost-effectiveness of continuous subcutaneous opioid infusion into the chest wall or trunk, intravenous opioid infusion for the management of severe cancer pain should be abandoned.
为比较皮下注射与静脉输注阿片类镇痛药的安全性和有效性，对住院患者进行了一项随机、双盲、交叉试验。15例重度癌痛患者接受了两次为期48小时的氢吗啡酮输注，一次皮下注射，一次静脉注射，顺序随机分配。整个研究通过使用两台输液泵实现双盲；在皮下积极输注期间，静脉输液泵输注生理盐水，反之亦然。通过视觉模拟量表对疼痛强度、疼痛缓解、情绪和镇静进行的系列测量显示，两种输注途径在临床或统计学上均无显著差异。副作用轻微，两种途径用于缓解爆发性疼痛的吗啡注射平均次数无显著差异（静脉注射为4.8 [标准差4.5]，皮下注射为5.3 [5.6]）。输注24小时和48小时时测得的血浆氢吗啡酮浓度显示出稳定的稳态药代动力学；皮下输注的平均生物利用度为静脉输注的78%。由于连续皮下阿片类药物输注至胸壁或躯干具有操作简单、技术优势和成本效益，应放弃静脉输注阿片类药物治疗重度癌痛。
