Meyer Ilonka, Chan Brandon, Cohen Emma, Dube Esther, Hu Raymond, Yeomans Megan, Pontonio Frances, Heldreich Charlotte, O'Conghaile Stiofan, Holmes Natasha, Maroon Nada, Weinberg Laurence, Tan Chong O
Department of Anesthesia & Inpatient Pain Services, Austin Hospital, Level 2 Austin Towers, 145 Studley Rd Heidelberg, Melbourne, VIC, 3084, Australia.
Department of Haematology, Austin Hospital, 145 Studley Rd Heidelberg, Melbourne, VIC, 3084, Australia.
Support Care Cancer. 2022 Jul;30(7):6013-6020. doi: 10.1007/s00520-022-07014-5. Epub 2022 Apr 11.
The aim of this study is to ascertain the analgesic efficacy and total oral morphine equivalent daily dose (OMEDD) effect of a buprenorphine-based analgesic protocol in the treatment of severe Oral Mucositis (OM).
This is a retrospective cohort study.
This study was done in a single Quaternary Referral Centre, Haematology Unit.
Fifty-four stem cell transplant patients suffering at least grade 3 oral mucositis (OM), 24 prior to [Pr-I] and 30 subsequent to [Po-I] a buprenorphine-based OM analgesic protocol.
We analysed data from the above subjects with the primary outcome measure of difference in total OMEDDs from all opioid types and administration routes, and secondary outcome measures of area under the curve (AUC) of 11-point Numerical Rating Scale (NRS-11) pain assessments, sedation scores and respiratory rate.
Post-protocol patients' total OMEDD requirements were significantly reduced [Pr-I: 1961 (1365)mg; Po-I: 928 (625)mg, p = 0.02], as were total NRS-11:hours AUC on swallowing [Pr-I: 54(24) score-hours; Po-I: 41(18) score-hours, p < 0.001]. There were no significant differences in objective measures of OM severity between groups (Number of Grade 3 or 4 OM severity assessments [mean (SD)] Pr-I: 5 (6.2); Po-I: 7 (5.1) or number of days Neutrophil count 0.0 or 0.1 × 10/L; Pr-I: 13 (5.4); Po-I: 15 (4.7)). 5 Pr-I and 4 Po-I patients required ketamine infusions, with 1 Pr-I patient also requiring IV lignocaine.
Use of Buprenorphine via transdermal, sublingual and intravenous Patient Controlled Analgesia (PCA) delivery as part of an analgesic protocol for severe post stem cell transplant oral mucositis in adult patients appears to significantly reduce opioid requirements and pain on swallowing. Further randomised prospective work is required to confirm these associations.
本研究旨在确定一种基于丁丙诺啡的镇痛方案在治疗重度口腔黏膜炎（OM）中的镇痛效果及口服吗啡等效日总剂量（OMEDD）效应。
这是一项回顾性队列研究。
本研究在一家单一的四级转诊中心血液科进行。
54例干细胞移植患者，至少患有3级口腔黏膜炎（OM），其中24例在采用基于丁丙诺啡的OM镇痛方案之前[Pr-I]，30例在之后[Po-I]。
我们分析了上述研究对象的数据，主要结局指标为所有阿片类药物类型和给药途径的OMEDD总量差异，次要结局指标为11点数字评定量表（NRS-11）疼痛评估的曲线下面积（AUC）、镇静评分和呼吸频率。
方案实施后患者的OMEDD总需求量显著降低[Pr-I：1961（1365）mg；Po-I：928（625）mg，p = 0.02]，吞咽时NRS-11：小时AUC总量也显著降低[Pr-I：54（24）评分-小时；Po-I：41（18）评分-小时，p < 0.001]。两组间OM严重程度的客观测量指标无显著差异（3级或4级OM严重程度评估次数[均值（标准差）]Pr-I：5（6.2）；Po-I：7（5.1）或中性粒细胞计数为0.0或0.1×10/L的天数；Pr-I：13（5.4）；Po-I：15（4.7））。5例Pr-I患者和4例Po-I患者需要氯胺酮输注，1例Pr-I患者还需要静脉注射利多卡因。
对于成年患者干细胞移植后严重口腔黏膜炎，采用经皮、舌下和静脉自控镇痛（PCA）方式使用丁丙诺啡作为镇痛方案的一部分，似乎可显著降低阿片类药物需求量及吞咽时的疼痛。需要进一步开展随机前瞻性研究来证实这些关联。
