がん疼痛治療を目的としたモルヒネ持続皮下注時におけるレスキュードーズとしての早送りの有効性と安全性の検討

抄録

There have been very few studies on the efficacy and safety of subcutaneous morphine “rescue doses” in patients being treated with continuous subcutaneous infusion of morphine for the management of cancer pain.
In order to evaluate the safety and efficacy of subcutaneous morphine rescue doses as an adjunct to a continuous subcutaneous basal infusion, we investigated the dosage range of the morphine rescue doses, the ratio of their dosage to the 24-hour baseline dosage, the change in pain score and adverse effects for 31 subcutaneous morphine rescue doses administered to 10 cancer patients, who were admitted to the Shizuoka Cancer Center over the 11-month period from April 2003 to February 2004.
As for the findings, the 24-hour baseline dose of morphine was 46.72±35.99 mg and the smallest and largest rescue doses were 0.4 mg and 8 mg, respectively. All of the rescue doses were equivalent to 4.16% of the 24-hour baseline dose. Following rescue doses, the pain score significantly decreased from 6.27±2.49 to 3.10±2.80 (p<0.001) and of the 31 rescue doses administered, 25 produced no adverse effects. In a few patients, the rescue doses brought on or exacerbated nausea/and or vomiting, (n=3), caused drowsiness (n=2) or dry mouth (n=1).
These results suggest that a subcutaneous morphine rescue dose equivalent to 4.16% of the 24-hour baseline dose of a continuous subcutaneous morphine infusion can significantly reduce pain and that adverse effects such as nausea, vomiting, drowsiness and dry mouth only occur in a few patients.