Oxaliplatin infusion-related venous pain: prevention by simultaneous intravenous fluids

Abstract

ObjectiveOxaliplatin is a cytotoxic agent frequently used in the treatment of gastrointestinal cancer patients. A known side effect of oxaliplatin administration via a peripheral vein is infusion-related pain. In this retrospective cohort study we compared the incidence of infusion-related pain in patients treated with oxaliplatin with or without simultaneous fluid infusion (FI) (800 mL glucose 5% in 2 hours).MethodsWe retrospectively defined two cohorts: Patients treated with oxaliplatin and simultaneous intravenous FI and the same number of patients treated without FI.The incidence of infusion-related venous pain was the primary outcome measure. Secondary outcomes included: Incidence of hypersensitivity reactions, infusion time, dose density, number of patients switched to a central venous catheter and incidence of peripheral neuropathy.Results100 patients were included, 50 patients in both groups. Baseline characteristics were comparable, except for age (median 66.8 vs 62.4 years in groups with and without FI; p=0.017), and body mass index (28.0 vs 25.7 kg/m2, respectively; p=0.012). Patients treated with simultaneous FI experienced significantly less vascular pain compared with those without FI (10% vs 78%, respectively; p<0.0001; OR 0.031 (95% CI: 0.01 to 0.098)). No difference was observed in dose density, treatment delay or the need of central venous catheter. Logistic regression analysis showed no confounders affecting the primary outcome. No adverse events of FI were observed.ConclusionConcurrent infusion of 800 mL glucose 5% with peripheral venous administration of oxaliplatin significantly reduces the incidence of infusion-related pain in gastrointestinal cancer patients and is highly feasible and affordable in everyday clinical practice.

High concentration of oxaliplatin may be a risk factor for vascular pain

“…They found that the incidence of vascular pain in the group simultaneously administered 800 mL of 5% glucose solution was significantly lower than that in the control group (10% vs. 78%; p < 0.0001). 30 This suggests that L-OHP at a lower concentration may have affected vascular pain with the concurrent administration of 5% glucose solution, supporting the results of this study.…”

“…van Ravenstejin et al analysed the effect of co‐administration of 5% glucose solution during L‐OHP administration on the suppression of vascular pain in a retrospective cohort study. They found that the incidence of vascular pain in the group simultaneously administered 800 mL of 5% glucose solution was significantly lower than that in the control group (10% vs. 78%; p < 0.0001) 30 …”