Ferraz Gonçalves José António, Sousa Filipa, Alves Lucy, Liu Patrícia, Coelho Sara
Serviço de Cuidados Paliativos, Instituto Português de Oncologia, 4200-072 Porto, Portugal.
Serviço de Medicina Interna, Centro Hospitalar Tondela Viseu, 3504-509 Viseu, Portugal.
Pharmacy (Basel). 2020 Dec 16;8(4):240. doi: 10.3390/pharmacy8040240.
Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1-20), and the median final 24-h dose of alfentanil was 5 mg (1-60), ( < 0.001). The initial 24-h median number of rescue doses was 2 (0-8), and the final median number of rescue doses was 1 (0 to 8), ( = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.
阿芬太尼用于姑息治疗中的慢性疼痛缓解。然而，关于其使用的数据却很匮乏。因此，决定对阿芬太尼在姑息治疗中的使用情况进行回顾。在一家姑息治疗机构开展了回顾性研究。研究对象为2018年1月至2019年4月期间接受阿芬太尼静脉或皮下持续输注以缓解疼痛的患者病历。在113例入院患者中，共有111例接受了阿芬太尼治疗。其中，男性56例，中位年龄为70岁。使用阿芬太尼的中位天数为6天（范围1至129天）。改用阿芬太尼最常见的主要原因是52例（46%）患者疼痛控制不佳和24例（21%）患者肾功能损害。阿芬太尼的24小时初始中位剂量为4毫克（1 - 20），最终24小时中位剂量为5毫克（1 - 60），（P < 0.001）。初始24小时救援剂量的中位次数为2次（0 - 8），最终救援剂量的中位次数为1次（0至8），（P = 0.025）。在56例使用阿芬太尼至少7天的患者中，3例（5%）剂量降低，10例（18%）保持稳定，43例（77%）剂量增加。使用阿芬太尼129天的患者在此期间剂量保持不变。阿芬太尼可能是一种有用的二线阿片类药物。阿芬太尼诱导耐受性的速度似乎并不特别快。
