2003 Volume 18 Issue 3 Pages 121-126
Introduction: For decades, morphine was the only strong opioid for the treatment of cancer pain in Japan. From March 2002, transdermal fentanyl patch has been applied to cancer patients previously treated with morphine. As a consequence, opioid rotation from morphine to fentanyl patch (DurotepTM patch) became major concern for physicians to control cancer pain in our country. In this article, we would like to introduce why and how we rotate the opioid, incidence of side efffects, and how we control breakthrough pain in our hospital.
Patients: During the period of March 2002 to July 2002, 12 patients were entrusted to the anesthesiology pain service from difficulty in controlling morphine side effects. Primary cancer of the patients were 4 stomach, 2 gallbladder, 1 liver, 1 pancreas, 1 ovarian, 1 breast, 1 thyroid, and 1 lingual cancer. All patients were given morphine either orally, rectally, or intravenously and were scheduled for opioid rotation. They were all suffering from intractable side effect of morphine, possible digestive tract obstruction, and/or pruritis.
Methods: Direct conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 was basically enforced, however, varied depending on patient status. We also gave intravenous morphine using patient controlled analgesia (PCA) for rescue in several patients with severe breakthrough pain. Numeric rating scale (NRS), nausea score and drowsiness score was obtained for 72 hours during the rotation. Constipation was not evaluated as this study was designed for only 72 hours.
Results: The median Numeric rating scale (NRS) at rest decreased from 4.5 to 3.0 at 72 hours after the rotation, however not significant. Nausea was present in 10 patients, and resolved completely in 6 patients. There were no significant increase in drowsiness score. One patient with pruritis, possibly due to morphine, disappeared soon after the end of rotation.
Conclusion: Opioid rotation to transdermal fentanyl patch, under discreet assessment and rotation planning, is beneficial for cancer pain relief in patients requiring strong opioid analgesics if they were naive to previously given morphine.
