Efficacy of small dose dexmedetomidine mixed with morphine for PCIA in patients with cancer pain complicated with opioid tolerance-oral difficulty
10.3760/cma.j.issn.0254-1416.2018.08.011
- VernacularTitle:小剂量右美托咪定混合吗啡PCIA对阿片类药物耐受-口服困难患者癌痛的疗效
- Author:
Guanglun XIE
1
;
Wei ZHANG
;
Zhigang LI
;
Dapeng GUO
;
Chang LIU
Author Information
1. 450000,郑州大学附属肿瘤医院疼痛科
- Keywords:
Pain;
Cancer;
Analgesia,patient-controlled;
Dexmedetomidine;
Morphine
- From:
Chinese Journal of Anesthesiology
2018;38(8):937-941
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the efficacy of small dose dexmedetomidine mixed with mor-phine for patient-controlled intravenous analgesia ( PCIA) in patients with cancer pain complicated with opi-oid tolerance-oral difficulty. Methods Sixty patients with moderate to severe cancer pain complicated with opioid tolerance-oral difficulty were divided into morphine group ( M group, n=30) and dexmedetomidine plus morphine group ( DM group, n=30) using a random number table method. Morphine 200 mg was di-luted to 200 ml in normal saline in group M. Morphine 200 mg plus dexmedetomidine 600μg was diluted to 200 ml in normal saline in group DM. PCIA was performed ( background infusion 0. 5-1. 0 ml∕h, bolus dose 0. 5-1. 0 ml, lockout interval 15 min) on the basis of the original narcotic analgesics in two groups. The target of analgesia was numeric rating scale score≤3, the number of pain occurred per day <3 times, and pain could be rapidly relieved by pressing PCA pump. When the target of analgesia was not achieved or adverse reactions occurred without opioid tolerance within 72 h, minimally invasive analgesia was performed according to condition. Numeric rating scale score, effective analgesia, minimally invasive analgesia, con-sumption of opioids ( the consumption of opioids was converted into the amount of morphine taken orally) , patient′s satisfaction score, quality of life score and drug-related adverse reactions were recorded before PCIA and at 3 days and 1 month of PCIA. Results Compared with group M, the consumption of opioids was significantly decreased at 3 days and 1 month of PCIA, and no significant change was found in the rate of effective analgesia, rate of minimally invasive analgesia, quality of life score, satisfaction score or inci-dence of adverse reactions in group DM ( P>0. 05) . Hyperalgesia, respiratory depression or marked change in blood pressure was not found in two groups. Compared with the baseline before PCIA, the incidence of somnolence at 3 days of PCIA and incidence of constipation at 1 month of PCIA were increased in group M, and the incidence of somnolence was increased at 3 days and 1 month of PCIA in group DM (P<0. 05). Conclusion PCIA with small dose dexmedetomidine mixed with morphine can reduce the consumption of opioids and exert safe and effective analgesic efficacy when used for the patients with cancer pain complicat-ed with opioid tolerance-oral difficulty.
