Abstract
The efficacy of opioid rotation of 20% of morphine to intravenous compound oxycodone, while giving 80% of the original dose of morphine, for morphine-induced delirium in cancer patients was studied. Thirty-two consecutive patients who were admitted and treated with intravenous morphine and developed delirium in a palliative ward were prospectively studied. Opioids were given by patient-controlled analgesia method. The degree of delirium, pain, and sleepiness was assessed by the Japanese version of Memorial Delirium Assessment Scale (MDAS-J), face scale (FS), and the Japanese version of Schedule for Treatment Assessment Scale (STAS-J), respectively, before and 3 days after partial opioid rotation to compound oxycodone. Five patients were excluded from the analyses because of changed management of pain control (n=2) and brain metastases (n=3). The results were analyzed in the remaining 27 patients. Delirium improved after partial rotation to compound oxycodone in 21 (78%) of the 27 patients. The mean degree of delirium improved from 16.2 to 9.2 on MDAS-J, pain from 2.2 to 1.7 on FS, and sleepiness from 2.6 to 1.7 on STAS. We conclude that partial rotation of morphine to compound oxycodone is effective to improve morphine-induced delirium in patients with cancer pain.
