Løhre Erik Torbjørn, Svedahl Augstein, Jakobsen Gunnhild, Solheim Tora Skeidsvoll, Klepstad Pål, Thronæs Morten
Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Pain Ther. 2023 Apr;12(2):593-605. doi: 10.1007/s40122-023-00485-2. Epub 2023 Feb 18.
Dexmedetomidine, an alpha-2 adrenergic receptor agonist with potential opioid sparing properties, is utilized in palliative medicine, but the knowledge base for this practice is limited. We describe concomitant use of dexmedetomidine and opioids in an acute palliative care unit.
We included all hospitalized palliative cancer care patients treated with dexmedetomidine from January 2019 to January 2021. Demographics, opioid doses, dexmedetomidine indications and dosing, reported effects and adverse responses, as well as treatment lengths were recorded.
Three women and six men aged 42-66 years with metastatic cancer and Eastern Cooperative Oncology Group (ECOG) performance status I-IV used dexmedetomidine and opioids concomitantly. Indications for dexmedetomidine were pain (n = 7) and anxiety (n = 2). Dexmedetomidine was administered intravenously in two patients and subcutaneously in seven. All administrations were continuous infusions; initial doses ranged from 240 to 1344 µg/24 h with later doses from 240 to 2440 µg/24 h. Physicians reported relief from pain and anxiety, but two patients required neuraxial pain management during admission. At day 2 of dexmedetomidine treatment, the opioid dose was reduced in six out of nine patients. For all patients with available data at day 7, mean opioid dose was reduced to 74% of the initial dose. When excluding the two patients requiring neuraxial pain management, the corresponding number was 80%. Two patients had transient hypotension, but dexmedetomidine was well tolerated and in no cases withdrawn due to adverse effects. Mean dexmedetomidine treatment length was 40 days.
Dexmedetomidine treatment decreased opioid consumption and was well tolerated in a retrospective study of nine palliative cancer care patients. It may represent a treatment option late in the disease trajectory.
右美托咪定是一种具有潜在阿片类药物节省特性的α-2肾上腺素能受体激动剂，用于姑息治疗，但该实践的知识基础有限。我们描述了右美托咪定与阿片类药物在急性姑息治疗病房中的联合使用情况。
我们纳入了2019年1月至2021年1月期间接受右美托咪定治疗的所有住院姑息性癌症护理患者。记录了人口统计学信息、阿片类药物剂量、右美托咪定的适应证和剂量、报告的效果和不良反应以及治疗时长。
9名年龄在42 - 66岁之间的转移性癌症患者（3名女性和6名男性），东部肿瘤协作组（ECOG）体能状态为I - IV级，同时使用了右美托咪定和阿片类药物。右美托咪定的适应证为疼痛（n = 7）和焦虑（n = 2）。2名患者静脉注射右美托咪定，7名患者皮下注射。所有给药均为持续输注；初始剂量范围为240至1344μg/24小时，后续剂量为240至2440μg/24小时。医生报告疼痛和焦虑得到缓解，但有2名患者在住院期间需要进行神经轴性疼痛管理。在右美托咪定治疗的第2天，9名患者中有6名阿片类药物剂量减少。对于第7天有可用数据的所有患者，平均阿片类药物剂量降至初始剂量的74%。排除2名需要神经轴性疼痛管理的患者后，相应数字为80%。2名患者出现短暂性低血压，但右美托咪定耐受性良好，无一例因不良反应停药。右美托咪定的平均治疗时长为40天。
在一项对9名姑息性癌症护理患者的回顾性研究中，右美托咪定治疗减少了阿片类药物的用量，且耐受性良好。它可能是疾病晚期的一种治疗选择。
