Akciğer kanserli hastaların ağrılarının tedavisinde transdermal fentanil ve yavaş salınımlı morfinin karşılaştırılması
AMAÇ: Randomize ve kontrollü olan bu çalışmanın birincil amacı, akciğer kanserine bağlı kronik ağrılı olgularda, TDF ile YSM’ in erken dönem analjezik etkinliklerinin ve ikincil amacı ise yan etkilerinin değerlendirilmesidir. GEREÇ-YÖNTEM: Dünya Sağlık Örgütü’ nün önerdiği basamak tedavisine göre 3. basamak tedaviyi gerektiren 50 kronik akciğer kanserli hasta, 15 günlük çalışma süreci için ya transdermal fentanil (Grup F, n=25) ya da yavaş salınımlı oral morfin (Grup M, n=25) aldı. Olgular sayısal sıralamalı ağrı skorları ve performans durumlarının yanısıra, konstipasyon, bulantı-kusma, hipoventilasyon, idrar retansiyonu ve ürtiker gibi ilaç yan etkileri açısından da günlük olarak değerlendirildi. BULGULAR: Gruplar arasındaki başlangıç ağrı skorları benzerdi (p>0.05) Yedinci ve 15. günlerdeki ağrı skorları, başlangıç değerleri ile karşılaştırıldığında Grup F ve Grup M olgularında anlamlı olarak daha düşük olmasına rağmen (p>0.001), gruplar arasında farklılık göstermedi (p>0.05). Grup M ile karşılaştırıldığında, konstipasyon sıklığı Grup F’ de anlamlı olarak daha düşük (sırasıyla, 14 olgu, %64 ve 6 olgu, %27) idi (p=0.03). Bulantı-kusma, idrar retansiyonu ve ürtiker görülme sıklıkları guplar arasında anlamlı farklılık göstermedi (sırasıyla p>0.05). Hiç bir olguda hipoventilasyon gelişmedi. SONUÇ: Akciğer kanserine bağlı kronik ağrıların giderilmesinde, hem transdermal fentanil hem de yavaş salınımlı morfin güvenli ve etkili analjezi sağlamaktadır. Ancak TDF, anlamlı olarak daha az konstipasyona neden olmaktadır.
Anahtar Kelimeler:
Fentanil, Akciğer neoplazmları, Morfin, Uzun etkili ilaçlar, Ağrı, Ağrı ölçümü
Comparison of TD-fentanyl with sustained-release morphine in the pain treatment of patients with lung cancer
Comparison of TD-fentanyl with Sustained-Release Morphine in the Pain Treatment of Patients with Lung Cancer AIM: The aim of this randomized and controlled trial was to evaluate the analgesic efficacy of trans-dermal fentanyl (TDF) and sustained-release oral morphine (SRM) primarily and their side effects secondarily, in patients with chronic lung cancer-related pain. MATERIAL-METHODS: According to three step analgesic guidelines recommended by the World Health Organization, 50 chronic lung cancer patients requiring third line therapy were enrolled and received either TDF patch (Grup F, n=25) or SRM per orally (Grup M, n=25) for 15 days. Patients were assessed in view to numeric rating scale of their pain, as well as the drugs’ side effects like constipation, nausea-vomiting, urinary retention and urticaria, hypoventilation. RESULTS: Pain scores were similar for both groups at the beginning (p>0.05). While significantly lower pain scores were achieved on the 7th and 15th days compared to those of initial values in Group F and Group M patients (p<0.001); these decreases did not reach statistical significance between the groups (p>0.05). Compared to Group M, constipation was significantly lower in Group F (14 patients and 64% vs. 6 patients and 27%, respectively) (p=0.03). However, the frequencies of nausea-vomiting, urinary retention and urticaria were different between the groups (p>0.5). None of the patients developed hypoventilation. CONCLUSION: Both TDF and SRM are safe and effective analgesics for the management of chronic cancer pain. However, TDF is associated with significantly less constipation rate than that of with SRM.
Keywords:
Fentanyl, Lung Neoplasms, Morphine, Delayed-Action Preparations, Pain, Pain Measurement,
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- ISSN: 1300-0012
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 2018
- Yayıncı: Ali Cangül
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