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Comparison of two techniques (intermittent intravenous bolus morphine vs. morphine infusion) for analgesic titration in patients who had advanced cancer with severe pain: a prospective randomised study
  1. Vinod Kumar1,
  2. Prashant Sirohiya2,
  3. Rakesh Garg1,
  4. Nishkarsh Gupta1,
  5. Sachidanand Jee Bharti1,
  6. Thirumurthy Velpandian3,
  7. Seema Mishra1 and
  8. Sushma Bhatnagar1
  1. 1Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Anaesthesia, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
  3. 3Department of Ocular Pharmacology, Dr Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Vinod Kumar, Department of Onco-Anaesthesia and Palliative medicine, All India Institute of Medical Sciences, New Delhi 110029, India; vkchanpadia{at}gmail.com

Abstract

Objective To compare the analgesic efficacy of two techniques of morphine titration (intermittent intravenous bolus vs infusion) by calculating rescue dosage in a day at 1 week after analgesic titration.

Methods One hundred and forty cancer patients were randomised into two groups. In group 1, intravenous morphine 1.5 mg bolus given every 10 min until Numerical Rating Scale (NRS) pain score <4 is achieved. Total intravenous dose converted to oral dose (1:1) and administered every 4 hours. In group 2, intravenous bolus morphine 0.05 mg/kg body weight administered followed by 0.025 mg/kg/hour intravenous infusion. The NRS pain score was recorded every 10 min but infusion rate was titrated every 30 min if required. The infusion rate of morphine was doubled if the pain score was unchanged and increased to 50% when NRS was between 4 and baseline. If NRS<4, then infusion at same rate was continued. Once the NRS<4 for two consecutive hours, total intravenous dose for 24 hours was calculated and converted to oral morphine in a ratio of 1:3 and divided into six doses given over 24 hours. For rescue (pain score ≥4) analgesia, one-sixth of the total daily oral dose was prescribed. The primary outcome of this study was to note the number of rescue doses of oral morphine in a day at 1 week.

Results The rescue dosage in a day at 1-week post discharge from the palliative care unit was significantly higher in group 1 as compared with group 2.

Conclusion Intravenous infusion morphine may be a better analgesic titration technique for analgesia in patients with advanced cancer.

Trial registration number CTRI/2018/04/013369.

  • cancer
  • pharmacology
  • symptoms and symptom management
  • supportive care
  • pain
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Footnotes

  • Contributors VK, PS, RG, NG, SJB, TV, SM and SB contributed to study design and implementation of the study and analysis of the dataset, provided critical feedback and revisions on the manuscript, and approved the final version for submission.

  • Funding Received grant for this intramural project from AIIMS Research Section vide memorundum no.- F.No.8-414/A414/2016/RS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This randomised, prospective controlled trial was conducted in a palliative care unit of a tertiary care referral and teaching hospital from March 2016 to January 2019. The study protocol was approved by the Institute Ethics Committee (IEC/58/08.01.2016). Education was provided to study subjects with informed consent before their recruitment into the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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