Mercadante S, Villari P, Ferrera P, Casuccio A, Mangione S, Intravaia G
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
Br J Cancer. 2007 Jun 18;96(12):1828-33. doi: 10.1038/sj.bjc.6603811. Epub 2007 May 22.
The use of supplemental doses of opioids is commonly suggested to manage breakthrough pain. A comparative study of intravenous morphine (IV-MO) and oral transmucosal fentanyl citrate (OTFC) given in doses proportional to the basal opioid regimen was performed in 25 cancer patients receiving stable opioid doses. For each episode, when it occurred and 15 and 30 min after the treatment, pain intensity and opioid-related symptoms were recorded. Fifty-three couples of breakthrough events, each treated with IV-MO and OTFC, were recorded. In episodes treated with IV-MO, pain intensity decreased from a mean of 6.9 to 3.3 and to 1.7 at T1 and T2, respectively. In episodes treated with OTFC, pain intensity decreased from a mean of 6.9 to 4.1 and to 2.4 at T1 and T2, respectively. Statistical differences between the two treatments were found at T1 (P=0.013), but not at T2 (P=0.059). Adverse effects were comparable and were not significantly related with the IV-MO and OTFC doses. Intravenous morphine and OTFC in doses proportional to the scheduled daily dose of opioids were both safe and effective, IV-MO having a shorter onset than OTFC. Future comparative studies with appropriate design should compare titration methods and proportional methods of OTFC dosing.
通常建议使用补充剂量的阿片类药物来控制爆发性疼痛。对25名接受稳定阿片类药物剂量的癌症患者进行了一项比较研究，比较按基础阿片类药物治疗方案比例给予的静脉注射吗啡（IV-MO）和口服黏膜芬太尼枸橼酸盐（OTFC）。对于每一次发作，记录发作时以及治疗后15分钟和30分钟的疼痛强度和阿片类药物相关症状。记录了53对爆发性事件，每对事件分别用IV-MO和OTFC进行治疗。在用IV-MO治疗的发作中，疼痛强度在T1和T2时分别从平均6.9降至3.3和1.7。在用OTFC治疗的发作中，疼痛强度在T1和T2时分别从平均6.9降至4.1和2.4。两种治疗方法在T1时存在统计学差异（P=0.013），但在T2时无差异（P=0.059）。不良反应相当，且与IV-MO和OTFC的剂量无显著相关性。按阿片类药物每日预定剂量比例给予的静脉注射吗啡和OTFC均安全有效，IV-MO的起效时间比OTFC短。未来设计合理的比较研究应比较OTFC给药的滴定法和比例法。
