Ayşegül BİLEN, ACHMET ALİ, Fulya BATURAY, Beysim ÖZCAN, HATİCE AYSEL ALTAN

Kronik kanser ağrısı tedavisinde güçlü ve zayıf opioidlerin birlikte kullanımı

Amaç: Çalışmamızda, transdermal fentanil (TDF) kullanılan kronik kanser hastalarında doz artımı gerektiğinde TDF dozun- da artım yapmadan önce tedaviye tramadol eklenmesinin kanser ağrısı kontrolünde avantaj sağlayıp sağlamayacağını araştırdık. Gereç ve Yöntem: Hastalar; Grup Kontrol (Grup K) ve Grup Tramadol (Grup T) olarak iki gruba ayrıldı. Hastalar ağrı polik- liniğimize ilk başvurduklarında demografik özellikleri, kanser türü, ağrı çekme süresi ve ilk VAS değerleri kaydedildi. Hastalara muayene sonrası ilk tedavi olarak 25 μg/saat fentanil içeren TDF verildi. Çalışma esnasında, Grup K’de hastaların kullandığı TDF dozu; doz yükseltilmesine gerek duyulan her muayenede 25 μg/saat yükseltildi. Tramadol grubunda ise ilk doz yükseltil- mesi gerektiğinde TDF dozu arttırılmadan tedaviye 200 mg tramadol eklendi. Grup T’de daha sonra doz artırımı gerektiğinde tramadol kesilmeden TDF dozu ardışık olarak ihtiyaç halinde 25 μg/saat arttırıldı. Hastaların her poliklinik muayenesinde VAS skorları, yan etkiler kaydedildi. Ayda bir hastaların uyguladığımız ağrı tedavisini tedavi değerlendirme skalası (TDS) ile değerlendirmeleri istendi. Çalışma sonunda hastaların çalışmaya katılım süreleri ve ulaşılan en üst TDF dozu kaydedildi. Ayrıca hastaların 50 μg/saat, 75 μg/saat, 100 μg/saat, 125 μg/saat ve 150 μg/saat TDF dozlarına kaç gün içerisinde ulaştıkları saptandı. Bulgular: Çalışma başlangıcından 1 ay ve 2 ay sonra ölçülen TDS skoru gruplar arasında benzer bulundu. Fakat 3. ay ve 4. ay so- nunda ölçülen TDS skoru GrupT’de anlamlı ölçüde yüksek saptandı. Çalışma sonunda ulaşılan ortalama TDF dozu Grup K’de Grup T’ye göre anlamlı ölçüde yüksek bulundu. Çalışmaya katılan hastalarda kaşıntı Grup K’de anlamlı ölçüde daha sık görüldü. Sonuç: Çalışmamızda TDF ile tramadolün birlikte kullanıldığında, TDF ihtiyacını azalttığını buna bağlı olarak kronik ağrı tedavisi protokolümüzün hastalar tarafından daha iyi tolere edildiğini saptadık. Çalışmamız verileri ışığında, kanser ağrısı tedavisinde güçlü ve zayıf opioid analjeziklerin birlikte kullanılmasını önermekteyiz.

Concomitant use of strong and weak opioids in the management of chronic cancer pain

Objectives: Our aim was to search whether the addition of Tramadol affected treatment when a dose increase was needed before increasing the transdermal fentanyl (TDF) dose in cancer patients using TDF would have any advantages. Methods: Patients were divided into two groups: a Control Group (Group K) and a Tramadol Group (Group T). When patients were first admitted to the polyclinic, demographic data, duration of pain and the first VAS values were recorded. Following the first examination, all patients were given TDF containing 25 μg/h of fentanyl as an initial treatment. During the study period, the TDF dose of patients in Group K was increased in a stepwise fashion of 25 μg/h whenever needed. In Group T, 200 mg of tramadol was added to the treatment without increasing the TDF dose when a dose increase was needed. In subsequent dose increase requirements in Group T, the TDF dose was sequentially increased to 25 μg/h when needed without stopping tramadol. Patients VAS score and adverse effects were recorded in each polyclinic examination. Patients were asked to assess pain treatment with the Treatment Assess- ment Scale (TAS). Each patient’s participation in the study and highest TDF dose reached were recorded. Results: The TDS scores measured at 1 month and 2 months after the start of the study were found to be similar. However, TAS scores measured at the end of the 3rd and 4th months were found to be significantly higher in Group T. The mean TDF dose reached at end of the study was found to be significantly higher in Group K compared to Group T. Itching was observed significantly more frequently among patients of Group K. Conclusion: We found in our study that when TDF and tramadol are used together, TDF need is reduced and the pain management protocol is better tolerated by patients. Based on the results of our study, we suggest concomitant use of strong and weak opioids.

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