Mercadante Sebastiano, Intravaia Giuseppe, Villari Patrizia, Ferrera Patrizia, Riina Salvatore, Mangione Salvatore
Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, University of Palermo, Palermo, Italy.
J Pain Symptom Manage. 2008 Mar;35(3):307-13. doi: 10.1016/j.jpainsymman.2007.04.018. Epub 2008 Jan 7.
The aim of this prospective cohort study was to confirm the safety of intravenous morphine (IV-M) used in doses proportional to the basal opioid regimen for the management of breakthrough pain and to record the nurse compliance on regularly recording data regarding breakthrough pain treated by IV-M. Over a one-year period, 99 patients received IV-M for breakthrough pain during 116 admissions. The IV-M dose was 1/5 of the oral daily dose, converted using an equianalgesic ratio of 1/3 (IV/oral). For each episode, nurses were instructed to routinely collect changes in pain intensity and emerging problems when pain became severe (T0), and to reassess the patient 15minutes after IV-M injection (T15). Nurses were unaware of the aim of the study and just followed department policy. In total, 945 breakthrough events treated by IV-M were recorded and the mean number of events per patient per admission was eight (95% confidence interval (CI) 6.9-9.5). The mean dose of IV-M was 12mg (95% CI 9-14mg). In the 469 events (49.6%) with a complete assessment, a decrease in pain of more than 33% and 50% was observed in 287 (61.2%) and 115 (24.5%) breakthrough events, respectively. The mean pain intensity decreased from 7.2 (T0) to 2.7 (T15). In eight episodes, no changes in pain intensity were observed and a further dose of IV-M was given. The remaining patients did not require further interventions. No clinical events requiring medical intervention were recorded. In this confirmatory study, IV-M was administered for the management of breakthrough pain in doses proportional to the basal opioid regimen to all patients, including older patients and those requiring relatively large doses. This did not result in life-threatening adverse effects in a large number of patients and was effective in most cases. The role of nurses is of paramount importance in monitoring and collecting data and gathering information for audit purposes on the unit.
这项前瞻性队列研究的目的是确认静脉注射吗啡（IV-M）用于治疗爆发性疼痛时，按基础阿片类药物治疗方案的比例给药的安全性，并记录护士在定期记录IV-M治疗爆发性疼痛相关数据方面的依从性。在一年的时间里，99名患者在116次住院期间接受了IV-M治疗爆发性疼痛。IV-M剂量为口服日剂量的1/5，使用1/3（静脉注射/口服）的等效镇痛比进行换算。对于每一次发作，护士被指示在疼痛严重时（T0）常规收集疼痛强度变化和出现的问题，并在IV-M注射后15分钟（T15）重新评估患者。护士不知道该研究的目的，只是遵循科室政策。总共记录了945次IV-M治疗的爆发性事件，每位患者每次住院的平均事件数为8次（95%置信区间（CI）6.9-9.5）。IV-M的平均剂量为12mg（95%CI 9-14mg）。在469次（49.6%）有完整评估的事件中，分别在287次（61.2%）和115次（24.5%）爆发性事件中观察到疼痛减轻超过33%和50%。平均疼痛强度从7.2（T0）降至2.7（T15）。在8次发作中，未观察到疼痛强度变化，并给予了进一步剂量的IV-M。其余患者不需要进一步干预。未记录到需要医疗干预的临床事件。在这项验证性研究中，对所有患者，包括老年患者和需要相对大剂量药物的患者，均按基础阿片类药物治疗方案的比例给药IV-M以治疗爆发性疼痛。这在大量患者中未导致危及生命的不良反应，且在大多数情况下是有效的。护士在监测和收集数据以及为科室审计目的收集信息方面的作用至关重要。
