Department of Oncology, City Hospital, Rimini, Italy.
Palliat Med. 2011 Jul;25(5):478-87. doi: 10.1177/0269216311404274.
To assess the role of transdermal opioids as a front-line approach to moderate to severe cancer pain.
A systematic review of the literature was performed by two authors. An analysis of the level of evidence and risk/benefit ratio was performed for all of the selected trials. A combined analysis of the included studies to assess the level of evidence, risk/benefit ratio and strength of the recommendations was performed to determine the place of transdermal opioids in the treatment of cancer when compared with oral morphine.
Thirteen papers were included in the analysis. The level of evidence was considered low for transdermal opioids (without distinction between transdermal fentanyl and transdermal buprenorphine) or transdermal fentanyl, and very low for transdermal buprenorphine. The risk/benefit ratio was considered uncertain for both transdermal opioids (fentanyl and buprenorphine) considered together and transdermal fentanyl or buprenorphine alone. The strength of the final recommendations (using the GRADE system) was weak negative for transdermal opioids (transdermal fentanyl plus transdermal buprenorphine) and transdermal fentanyl, and strong negative for transdermal buprenorphine.
The use of slow release oral morphine probably remains the preferred approach for these patients, with the use of transdermal opioids to be reserved for selected patients.
评估透皮阿片类药物作为治疗中重度癌痛的一线方法的作用。
两位作者对文献进行了系统评价。对所有入选试验均进行了证据水平和风险/获益比分析。对纳入的研究进行综合分析，以评估与口服吗啡相比，透皮阿片类药物在癌症治疗中的证据水平、风险/获益比和推荐强度，从而确定透皮阿片类药物的地位。
13 篇论文纳入分析。透皮阿片类药物（未区分透皮芬太尼和透皮丁丙诺啡）或透皮芬太尼的证据水平被认为较低，透皮丁丙诺啡的证据水平则非常低。考虑到两种透皮阿片类药物（芬太尼和丁丙诺啡）或单独使用透皮芬太尼或丁丙诺啡的风险/获益比均不确定。（使用 GRADE 系统）的最终推荐强度为弱否定，用于透皮阿片类药物（透皮芬太尼加透皮丁丙诺啡）和透皮芬太尼，用于透皮丁丙诺啡则为强否定。
对于这些患者，可能仍首选使用缓释口服吗啡，而仅将透皮阿片类药物保留用于某些特定患者。
