Zhongguo quanke yixue (Dec 2022)
Curative Effect of Patient-controlled Intravenous Analgesia with Hydromorphone, Sufentanil or Morphine in Treatment of Refractory Cancer Pain with Dysphagia
Abstract
Background Patients with refractory cancer pain often have dysphagia, which increases the difficulty of treatment. Patient-controlled intravenous analgesia (PCIA) is a measure that can achieve sustained, effective and safe analgesia. Objective To investigate the efficacy and safety of PCIA with hydromorphone, sufentanil or morphine in treatment of refractory cancer pain with dysphagia. Methods A total of 102 patients with refractory cancer pain and dysphagia were selected from Department of Oncology and Hospice Care Center of the Second Hospital of Wuhan Iron and Steel (Group) Corporation from May 2020 to January 2022, and equally divided into hydromorphone PCIA group, sufentanil PCIA group and morphine PCIA group single-blindly and randomly. The Numerical Rating Scale (NRS) score, the frequency of episodes of breakthrough pain, the Morphine Equivalent Daily Dose (MEDD) , Pittsburgh Sleep Quality Index (PSQI) score, Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) score and the incidence of adverse reactions were compared among the three groups before and after treatment. Results The participants included 51 males and 51 females, with an average age of (60.2±6.3) years. There were no statistical differences in sex ratio, average age, degree of pain, NRS score, MEDD, distribution of primary cancer type, pain type and TNM classification of cancers among the three groups (P>0.05) . The NRS score and the frequency of episodes of breakthrough pain in three groups deceased significantly after treatment (P<0.05) . The type and time of treatment had interactive effects on both the NRS score and the frequency of episodes of breakthrough pain (P<0.05) . The type of treatment produced main effect on the NRS score and the frequency of episodes of breakthrough pain, so did the time of treatment (P<0.05) . The NRS score and the frequency of episodes of breakthrough pain of hydromorphone PCIA group were significantly lower than those of each of other two groups after 24 hours or 72 hours of treatment (P<0.05) . Morphine PCIA group had higher NRS score than other two groups (P<0.05) , and had higher frequency of episodes of breakthrough pain than hydromorphone PCIA group (P<0.05) after one-week treatment. Morphine PCIA group had higher NRS score and frequency of episodes of breakthrough pain than each of other two groups after two-week or one-month treatment (P<0.05) . After one-month treatment, all groups demonstrated increased MEDD and decreased PSQI (P<0.05) . In particular, morphine PCIA group had higher MEDD than other two groups (P<0.05) . Sufentanil PCIA group had higher MEDD than hydromorphone PCIA group (P<0.05) . Morphine PCIA group had higher PSQI score than other two groups (P<0.05) . All groups demonstrated increased score of each item of the QLQ-C30 (P<0.05) . In particular, morphine PCIA group ranked bottom in terms of the score of each item of the QLQ-C30 (P<0.05) . The emotional function score of sufentanil PCIA group was significantly lower than that of hydromorphone PCIA group (P<0.05) . The incidence of adverse reactions had no significant differences among the three groups after one-month treatment (P>0.05) . Conclusion For patients with refractory cancer pain and dysphagia, hydromorphone and sufentanyl were superior to morphine for PCIA in terms of reducing pain and the frequency of episodes of breakthrough pain, improving quality of sleep and life. But hydromorphone was superior to sufentanyl in quick onset, and effective improvement of emotion with reduced dose of opioid and without increased incidence of adverse reactions.
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