Donner Barbara, Zenz Michael, Tryba Michael, Strumpf Michael
Departments of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Bergmannsheil, 44789 Bochum, Buerkle-de la-Camp Platz 1 Germany.
Pain. 1996 Mar;64(3):527-534. doi: 10.1016/0304-3959(95)00180-8.
Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine/transdermal fentanyl (100:1 mg) daily was examined in patients with cancer pain. Patients with a 'stable and low level of cancer pain' receiving a constant dosage of sustained release morphine during a pre-study phase of 6 days were included in the study. Initial fentanyl dosage was calculated by a conversion table. The transdermal system was changed every 72 h and the dosage was adjusted to the needs of the patients according to the VAS scores and the requirement of liquid morphine, which was allowed to achieve sufficient pain relief. Regression analysis at the end of the study revealed a mean morphine/transdermal fentanyl ratio of 70:1. Pain relief during treatment with transdermal fentanyl was identical to sustained release morphine. However, significantly more patients took supplemental medication with liquid morphine during transdermal fentanyl therapy. The number of patients suffering from pain attacks did not increase with transdermal fentanyl. Constipation and medication with laxatives decreased significantly during fentanyl therapy. Other side effects and vital signs were identical. Three patients suffered from a morphine withdrawal syndrome beginning within the first 24 h of transdermal fentanyl therapy. Cutaneous reactions to the patch were rare, mild and transient. Patients and physicians reported satisfaction with the transdermal therapy. 94.7% of the patients chose to continue the transdermal fentanyl therapy at the end of the study due to better performance in comparison to oral morphine. Due to these results an initial conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 is safe and effective.
在癌症疼痛患者中研究了口服吗啡与透皮芬太尼按每日口服吗啡/透皮芬太尼比例（100:1毫克）直接转换的情况。研究纳入了在为期6天的预研究阶段接受恒定剂量缓释吗啡且“癌症疼痛稳定且程度较低”的患者。初始芬太尼剂量通过转换表计算得出。每72小时更换一次透皮给药系统，并根据视觉模拟评分（VAS）和液体吗啡的需求对剂量进行调整，以实现充分的疼痛缓解。研究结束时的回归分析显示，吗啡/透皮芬太尼的平均比例为70:1。透皮芬太尼治疗期间的疼痛缓解情况与缓释吗啡相同。然而，在透皮芬太尼治疗期间，明显更多的患者需要补充液体吗啡。使用透皮芬太尼时，疼痛发作的患者数量并未增加。芬太尼治疗期间，便秘及使用泻药的情况显著减少。其他副作用和生命体征相同。3例患者在透皮芬太尼治疗的头24小时内出现吗啡戒断综合征。对贴片的皮肤反应罕见、轻微且短暂。患者和医生对透皮治疗表示满意。由于与口服吗啡相比表现更佳，94.7%的患者在研究结束时选择继续接受透皮芬太尼治疗。基于这些结果，口服吗啡与透皮芬太尼按100:1的比例进行初始转换是安全有效的。
