Intravenous morphine consumption in outpatients with cancer during their last week of life—an analysis based on patient-controlled analgesia data

Schießl, Christine; Sittl, Reinhard; Grießinger, Norbert; Lutter, N.; Schuettler, Juergen

doi:10.1007/s00520-007-0352-6

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…11.5.1, SPSS Inc opioid need which increases in the children's last days of life [6,10,22,23,29,31]. In adults, studies analysing opioid doses administered in the patients' last week of life showed only slight increases in the MED [12,13,28,34].…”

Section: Discussionmentioning

confidence: 95%

Use of patient-controlled analgesia for pain control in dying children

Schießl

Gravou

Zernikow

et al. 2008

Support Care Cancer

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Section: Discussionmentioning

confidence: 95%

Use of patient-controlled analgesia for pain control in dying children

Schießl

Gravou

Zernikow

et al. 2008

Support Care Cancer

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“…The use of outpatient opioid PCA to treat cancer pain has been described in several adult studies, [8, 10–12] in a review article of adult studies, [9] and in one study of combined adult and pediatric patients. [13] Even though the use of PCA in pediatric and young adult patients has not previously been specifically investigated in the outpatient setting, its safety in pediatric inpatients has been established. [2, 4, 7]…”

Section: Discussionmentioning

confidence: 99%

“…While extensive literature describes the use of PCA in the inpatient setting, little has been published describing its use for chronic pain management in the outpatient setting in adults, [8–12] and even fewer studies have included children in the study group [13] or examined the use of PCA in the outpatient setting for pain control in dying children. [1]…”

Section: Introductionmentioning

confidence: 99%

The Safety and Effectiveness of Patient-controlled Analgesia in Outpatient Children and Young Adults With Cancer

Anghelescu

Zhang²,

Faughnan³

et al. 2015

Journal of Pediatric Hematology/Oncology

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Background Patient-controlled analgesia (PCA) is safe and effective in hospitalized children; however, data regarding its use for outpatients are limited. The aims of the study are to determine the safety of outpatient PCA and to compare the standard and proxy PCA groups. Methods All patients receiving outpatient PCA over 54 months were included in this retrospective study. Data regarding age, sex, diagnosis, PCA initiation/discontinuation circumstances, patient vs. proxy-authorized PCA type, opioid doses, pain scores, and complications were collected. Nonparametric tests (Wilcoxon-Mann-Whitney test for comparing two groups or Kruskal-Wallis rank sum test for comparing more than two groups) were used to compare duration of PCA use, opioid doses, pain scores, and circumstances of initiation and discontinuation of outpatient PCA. Results Forty-five patients used 69 outpatient PCAs. The complication rate was 0.36%. The starting mean MED (mg/kg/day) was 1.67 when initiation was for an outpatient and 4.04 for those discharged from the hospital with PCA; this difference was not statistically significant (p=0.13). The analysis of mean opioid doses in relationship to the circumstances for the discontinuation of the outpatient PCA revealed a significantly higher dose (mg/kg/day) in the group of patients who died (19.54) than in the group with a change of status to inpatient or transfer to another hospital or hospice (3.70) and in the group in which PCA was discontinued because pain management no longer required a PCA (1.19). The mean opioid daily doses and pain scores were significantly higher at the end of life (p<0.0001). Conclusion Outpatient PCA use for children and young adults with cancer is safe.

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“…11 In a recent retrospective analysis of intravenous morphine patient-controlled analgesia in home care patients, opioid doses remained stable, in the range of 96 to 115 mg/d, in the last week of life, although the use of such a technique is questionable in severely ill patients. 12 In a hospice setting in United Kingdom, lower doses of opioids were used in the last week of life. The mean daily opioid dose increased from 42 to 55.5 mg over the last 7 days of life, with an increase in the number of patients receiving opioids from 61% at admission up to 89%.…”

Section: Discussionmentioning

confidence: 99%

“…Only 7% to 12% of patients required doses of more than 300 mg of morphine. [2][3][4][5][6][7][8][9][10][11][12][13] Unfounded concerns about the possible life-shortening effect of opioids may result in less than optimal symptom management in end-of-life care. 14 Some studies have examined the relationship between the use of opioid and survival but none of them reported that opioids had shortened life.…”

Section: Discussionmentioning

confidence: 99%

The Use of Opioids in the Last Week of Life in an Acute Palliative Care Unit

Mercadante

Ferrera

Casuccio

2010

Am J Hosp Palliat Care

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The aim of this survey was to assess the opioid use in the last week of life of cancer patients admitted at an acute palliative care unit. From a consecutive sample of patients surveyed for a period of one year, patients who died in the unit were selected. Type of opioid, route of administration, and doses were recorded one week before death (or at admission time if the interval admissiondeath was less than one week) (À7), and on the day of death (Tend). Seventy-seven patients died in the unit in the period taken into consideration (12.4%). Oral morphine equivalents were 170 mg/day and 262 mg/day at À7 and Tend, respectively. Patients were receiving transdermal drugs or intravenous morphine at Tend, with a trend in the use of intravenous morphine at Tend (p¼0.07). Intravenous morphine was more frequently used in sedated patients at Tend (p¼0.015).No differences in age, gender, opioid doses, and OEI were found among opioids used. In patients who were sedated doses of opioids were significantly increased (p¼0.012). In the last week of life intravenous morphine is the preferred modality to deliver opioids in an acute palliative care unit. Doses increases prevalently observed in sedated patients were performed before starting sedation with the purpose to treat concomitant distressing symptoms, such as dyspnoea.

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Intravenous morphine consumption in outpatients with cancer during their last week of life—an analysis based on patient-controlled analgesia data

Abstract: During their end-of-life phase, cancer patients on i.v. morphine PCA showed a stable daily opioid need.

Cited by 11 publications

References 24 publications

Use of patient-controlled analgesia for pain control in dying children

Use of patient-controlled analgesia for pain control in dying children

The Safety and Effectiveness of Patient-controlled Analgesia in Outpatient Children and Young Adults With Cancer

The Use of Opioids in the Last Week of Life in an Acute Palliative Care Unit

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