UI - 000196

AU - Portenoy RK

AU - Moulin DE

AU - Rogers AG

AU - Inturrisi CE

AU - Foley KM

TI - INTRAVENOUS INFUSION OF OPIOIDS IN CANCER-RELATED PAIN: REVIEW OF CASES

AND GUIDELINES FOR USE

AB - AB - Continuous iv infusion (CI) of opioid analgesics as an alternative approach to analgesia has

found increasing use in the management of postoperative pain and chronic pain. Despite the popularity of

CI, little documentation exists for its safety and efficacy. In order to assess these concerns, clinical

characteristics of 46 infusions in 36 patients with cancer-related pain were reviewed retrospectively. Hospital

charts were analyzed for patient characteristics, prior opioid exposure, rationale for iv administration of drug

and for CI, course of infusion, and outcome. Details of the characteristics of the study population are

presented in a table. All patients had cancer and all but one had active disease. Thirty-two patients had pain

due to tumor invasion, whereas three had pain caused by cancer therapy and one had pain unrelated to the

diagnosis of cancer. All patients had been exposed to opioid medications before the CI was begun. Thirty-six

infusions were begun with morphine sulfate, while methadone was used in four infusions, hydromorphone in

four, oxymorphone in one, and levorphanol in one. Additional medications, including the opioid analgesics,

were often given during the CI; their nature and frequency of use are tabulated. During 42 infusions, the max

infusion rate was greater than that at the start; during 17 infusions, the rate at CI termination was lower than

the max rate. Three patterns of dosing during CI were observed and are displayed graphically. The duration

of CI ranged from 1 to 45 days. Five patients were treated for less than 3 days, 13 for 4-6 days, 13 for 7- 13

days, 7 for 14-21 days, 3 for 22-29 days, 2 for 30-37 days, and 3 for 38-45 days. For 25 patients, the CI was

maintained until the patients died. Side effects due to the CI were difficult to determine precisely, since

34/46 patients were receiving repetitive iv bolus injections of opioids prior to CI, and the medical conditions

of the patients were often deteriorating during the infusion. Progressive sedation was by far the most

common side effect during CI. Respiratory depression, easily reversed with iv naloxone, occurred in a single

patient who received intrathecal morphine during CI. Safety and efficacy of CI are discussed. Guidelines in

the management of CI are listed in a table. (21 Refs) AD - Pain Research Program AD - Dept. of Neurology

AD - Memorial Sloan-Kettering Cancer Center AD - New York AD - NY 10021 UI - 87637003

SO - Adv Pain Res Ther 1986;8:413-424