Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

Autor: Judy Peters, Ebony L. Selers, Suellen M. Walker, Judith Middleton, Richard F. Howard, Mark G. Thomas, Muhammad Farhad Islam, Hayley McKenna, Kuan Ooi, Kirsty Keen, Reema Nandi, Matthew A Jay, Fiona Richards, Becky Saul, Glyn Williams, Elizabeth Robinson, Claire Vanstock, Suzanne Lilley
Rok vydání: 2021
Předmět:
Zdroj: Pediatric Anesthesia. 32:17-34
ISSN: 1460-9592
1155-5645
DOI: 10.1111/pan.14324
Popis: BACKGROUND Chemotherapy-induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy-induced severe oral mucositis in children and conducted a large single-center case series. METHODS Ovid MEDLINE, PubMed, and Cochrane databases were searched for studies reporting IV opioid duration and/or dose requirements for severe mucositis. Secondly, our pain service database was interrogated to describe episodes of opioid administration by patient- or nurse-controlled analgesia (PCA/NCA) for children with mucositis and cancer treatment-related pain. RESULTS Seventeen studies (six randomized trials, two prospective observational, three retrospective cohort, six retrospective case series) included IV opioid in 618 patients (age 0.3-22.3 years), but reported parameters varied. Mucositis severity and chemotherapy indication influenced IV opioid requirements, with duration ranging from 3 to 68 days and variable dose trajectories (hourly morphine or equivalent 0-97 mcg/kg/h). Our 7-year series included PCA/NCA for 364 episodes of severe mucositis (302 patients; age 0.12-17.2 years). Duration ranged from 1 to 107 days and dose requirements in the first 3 days from 1 to 110 mcg/kg/h morphine. Longer PCA/NCA duration was associated with: higher initial morphine requirements (ρ = 0.46 [95% CI 0.35, 0.57]); subsequent increased pain and need for ketamine co-analgesia (118/364 episodes with opioid/ketamine 13.9 [9.8-22.2] days vs opioid alone 6.0 [3.9-10.8] days; median [IQR]); but not with age or sex. CONCLUSIONS Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.
Databáze: OpenAIRE
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