FATMA GÜLÇİN ŞENEL, GONCA OĞUZ, Nesteren KOÇAK, Şerife KARACA, MENŞURE KAYA, Nihal KADIOĞULLARI

Palyatif bakım kliniğinde yatan kanser hastalarında ağrı tedavisi ve opioid kullanımı

Amaç: Ağrı, palyatif bakım kliniklerinde kanser hastalarının yaşam kalitesini belirgin olarak etkileyen önemli semptomlardan biridir. Gelişmekte olan ülkelerde opioidlere ulaşılabilirlikteki güçlükler ve iyi organize edilmiş palyatif bakım merkezlerinin azlığı ağrı tedavisinin yetersiz olmasına neden olmaktadır. Türkiye, kişi başına düşen opioid tüketiminin istatistiksel olarak yetersiz olduğu ülkelerden biridir. 2010 yılında kişi başına düşen opioid miktarı 14.31 mg morfin eşdeğeri olup, opioid analjezik tüketiminin yeterliliği %7 olarak bulunmuştur. Bu çalışmada palyatif bakım kliniğinde yatan hastalarda opioid kullanımı araştırıldı.Gereç ve Yöntem: 2014 yılında, palyatif bakım kliniğimizde palyatif bakım verilen 418 kanser hastasının verileri retrospektif olarak değerlendirildi.Bulgular: Hastaların 183'ü (%44) kadın, 235'i (%56) erkek olarak bulundu. Yaşlar 18 ve 93 yıl arasında değişmekteydi (61±15). Hastaların %9'una opioid verilmemişti, %26'sı zayıf opioid, %65'i güçlü opioid kullanmaktaydı. Hasta başına düşen günlük oral morfin eşdeğer dozu 172±58 mg (40-328) olarak bulundu. Opioid kullanımı için endikasyonlar %61 oranında ağrı, %19 oranında dispne ve %20 oranında ise hem dispne hem de ağrıydı.Sonuç: Ülkemizde opioid çeşitleri kısıtlı olmakla beraber tüm sağlık personelinin ağrı tedavisi ve opioid kullanımı hakkında eğitimi ile daha etkin ve yeterli ağrı tedavisi sağlanabileceği düşünüldü. Rölatif olarak zayıf opioidlerin yüksek kullanım insidansı, ülkemizde hızlı salınımlı opioidlerin eksikliğiyle ilişkili olabilir.

Opioid use and the management of cancer patient pain in palliative care clinic

Objectives: Pain is one of the most important symptoms in palliative care, and has a major impact on the quality of life of cancer patients. In developing countries, difficult access to opioids and the lack of well-established palliative care organizations result in undertreatment of pain. Turkey is one of the countries with statistical evidence of inadequate morphine consumption per capita. In 2010, the adequacy of opioid analgesic consumption was only 7%, based on a per capita consumption of 14.31 mg morphine equivalents. The present study analyzed and described patterns of opioid use among cancer patients in the palliative care clinic.Methods: The data of 418 cancer patients who received palliative care at the palliative care clinic in 2014 were evaluated retrospectively.Results: Of the total, 183 (44%) of the patients studied were female and 235 (56%) were male. Age ranged from 18 to 93 years (61±15 years). No opioids had been prescribed for 9% of patients, 26% of patients were using weak opioids, and 65% were using strong opioids. Daily oral morphine equivalent dosage per patient was 172±58 mg (range: 40-328 mg). Indications for opioid use were pain (61%), dyspnea (19%), and both dyspnea and pain (20%).Conclusion: Although there is a limited variety of opioids currently available in this country, it is thought that a more effective and adequate level of pain management can be obtained through education of health practitioners about pain management and opioid use. The relatively high incidence of weak opioid use may be associated with the lack of available rapid release opioids in the country.

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