Clinical study on withdrawal reactions during conversion of systemic opioid drugs to intrathecal morphine
Objective:To observe withdrawal reactions when systemic opioid medications are converted to intrathecal morphine for pain management and to explore the feasibility of patient-controlled intravenous treatment.Methods:Thirty patients who had suffering from intractable cancer pain and developed opioid tolerance in General Hospital of Eastern Theater Command from November 2022 to September 2023 were selected.After a 24-hour titration of intravenous morphine using patient controlled analgesia(PCA),a semi implantable intrathecal drug delivery system was implanted and connected to an intrathecal morphine infusion pump.The clinical opiate withdrawal scale(COWS)was employed to assess opioid withdrawal reactions(OWR)in patients during the transition from intravenous morphine to intrathecal,and the frequency,duration,and severity of OWR were recorded.Patients were categorized based on COWS scores into two groups:those without OWR(n = 7)and those with OWR(n = 23),further classified by the severity of OWR as mild(n = 4),moderate(n = 17),moderate to severe(n = 2),and severe(n = 0).Patients with OWR received intravenous morphine via PCA as needed.Evaluate the pain intensity,anxiety,depression,sleep,patient satisfaction and adverse opioid reactions of patients during the conversion process.Results:The incidence of OWR in patients in this study was 76.7%(23/30),with mild and moderate cases comprising 91.3%(21/23).Among them,87.0%(20/23)required relief via patient-controlled intravenous morphine.The moderate to severe OWR group had higher average COWS scores than the mild group(P＜0.05),and the moderate OWR group required more PCA administrations than the mild group(P＜0.05).The daily oral morphine milligram equivalents at admission of patients in the OWR group(n = 23)was positively correlated with the duration(r = 0.490,P = 0.018)and frequency(r = 0.488,P = 0.018)of OWR and the number of PCA administrations(r = 0.495,P = 0.016).After transition to intrathecal morphine,pain numerical rating scale(NRS)scores and daily morphine usage were significantly decreased compared with admission(P＜0.05),and anxiety,depression,sleep were all improved to varying degrees.The occurrence of constipation at discharge was significantly reduced compared with pre-operation(P＜0.01).Conclusion:The incidence of withdrawal reactions is relatively high when converting systemic opioid medications to intrathecal morphine for pain management.PCA intravenous morphine treatment is convenient and effective.
refractory cancer painopioid tolerancemorphinesemi implantable intrathecal drug delivery systemwithdrawal reaction
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维普
