Manfredi P L, Borsook D, Chandler S W, Payne R
Department of Anesthesia and Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
Pain. 1997 Mar;70(1):99-101. doi: 10.1016/s0304-3959(96)03313-1.
Methadone is a very effective second-line opioid for treatment of cancer pain. However, the starting doses of methadone indicated on opioid conversion charts may over-estimate the dose of intravenous (i.v.) methadone needed. In this report, we describe four patients with cancer-related pain treated with continuous i.v. morphine and hydromorphone. Because of persistent pain and opioid side effects limiting increases in opioid dose, each patient was switched to i.v. methadone. All four patients had excellent pain relief without significant side effects at a dose that, according to the available conversion charts, was approximately 3% of the calculated equianalgesic dose of hydromorphone. When converting from continuous i.v. hydromorphone to continuous i.v. methadone, much lower doses than those suggested by the opioid conversion charts should be used as starting doses.
美沙酮是治疗癌痛非常有效的二线阿片类药物。然而，阿片类药物转换表上所示的美沙酮起始剂量可能高估了所需静脉注射美沙酮的剂量。在本报告中，我们描述了4例接受持续静脉注射吗啡和氢吗啡酮治疗的癌痛患者。由于持续疼痛和阿片类药物副作用限制了阿片类药物剂量的增加，每位患者均改用静脉注射美沙酮。所有4例患者在根据现有转换表计算，约为氢吗啡酮等效镇痛剂量3%的剂量下，疼痛得到了极好的缓解且无明显副作用。从持续静脉注射氢吗啡酮转换为持续静脉注射美沙酮时，起始剂量应使用比阿片类药物转换表建议的剂量低得多的剂量。
