Developmental Neurosciences Programme (Paediatric Pain Research Group), UCL GOS Institute of Child Health, London, UK.
Department of Paediatric Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Paediatr Anaesth. 2022 Jan;32(1):17-34. doi: 10.1111/pan.14324. Epub 2021 Nov 11.
Chemotherapy-induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy-induced severe oral mucositis in children and conducted a large single-center case series.
Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis. Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient- or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain.
Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3-22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12-17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8-22.2] days vs opioid alone 6.0 [3.9-10.8] days; median [IQR]); but not with age or sex.
Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.
化疗引起的口腔黏膜炎可导致严重疼痛。建议使用静脉（IV）阿片类药物，但管理方案有所不同。我们系统地回顾了报告 IV 阿片类药物用于治疗儿童化疗引起的严重口腔黏膜炎相关疼痛的研究，并进行了一项大型单中心病例系列研究。
在 Ovid MEDLINE、PubMed 和 Cochrane 数据库中搜索报告 IV 阿片类药物持续时间和/或剂量要求的研究，以治疗严重黏膜炎。其次，我们的疼痛服务数据库被查询，以描述通过患者或护士控制镇痛（PCA/NCA）给予阿片类药物治疗黏膜炎和癌症治疗相关疼痛的患儿的发作情况。
17 项研究（6 项随机试验、2 项前瞻性观察、3 项回顾性队列、6 项回顾性病例系列）包括 618 例患者（年龄 0.3-22.3 岁）使用 IV 阿片类药物，但报告的参数有所不同。黏膜炎严重程度和化疗适应证影响 IV 阿片类药物的需求，持续时间从 3 天到 68 天不等，剂量轨迹也不同（每小时吗啡或等效物 0-97mcg/kg/h）。我们的 7 年系列包括 364 例严重黏膜炎（302 例患者；年龄 0.12-17.2 岁）的 PCA/NCA。持续时间从 1 天到 107 天不等，前 3 天的剂量需求从 1 到 110mcg/kg/h 吗啡不等。更长的 PCA/NCA 持续时间与：更高的初始吗啡需求（ρ=0.46 [95%CI 0.35，0.57]）；随后疼痛加剧和需要氯胺酮联合镇痛（118/364 例有阿片类药物/氯胺酮 13.9 [9.8-22.2] 天，而单独使用阿片类药物 6.0 [3.9-10.8] 天；中位数 [IQR]）；但与年龄或性别无关。
严重黏膜炎疼痛的管理可能需要长期的 IV 阿片类药物治疗。镇痛需求的个体和治疗相关差异突出表明需要由专科服务进行定期评估、滴定和管理。
