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Rhythmic pattern of PCA opioid demand in adults with cancer pain
Author(s) -
Schiessl C.,
Schestag I.,
Sittl R.,
Drake R.,
Zernikow B.
Publication year - 2010
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2009.06.009
Subject(s) - medicine , opioid , morning , bolus (digestion) , morphine , cancer pain , anesthesia , cancer , receptor
Patient‐controlled analgesia (PCA) has an established role in managing postoperative pain and has been successfully used in‐patients with cancer pain. The variation of opioid requirement over a 24h period for patients with cancer pain is debated with suggestions of reduced need over night. Methods: Retrospective review of 10years (1997–2006) data of all in‐patients with cancer pain treated with strong opioids delivered by PCA. Results: 141 patients with cancer pain had a mean cumulative 10day morphine equivalent dose per patient of 671mg (median 470mg; range 10–2170mg). At night (10:01pm to 06:00am) the patient's self administered less bolus doses (69mg, (25%)) than during the other two 8h periods (06:01am to 02:00pm, 91mg (33%) and 02:01pm to 10:00pm, 116mg (42%)). In 8 out of 10days a significant variation in bolus requests was observed with significantly less bolus requests during the night (Friedman test, p <0.05). Furthermore, the median number of delivered bolus requests per patient, at night, was 2–3 compared to the morning and afternoon periods of 3–7 and 3.5–6, respectively. Conclusion: PCA met individual patient's opioid needs in a safe and effective manner despite a large inter‐individual variability in opioid consumption. Moreover, the study indicated a pattern of less opioid requirement at night.