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American Society for Action on Pain

UI - 000198

AU - Portenoy RK

AU - Moulin DE

AU - Rogers A

AU - Inturrisi CE

AU - Foley KM

TI - I.v. infusion of opioids for cancer pain: clinical review and guidelines for use

AB - AB - To assess the safety, efficacy, and use of continuous iv infusion (CI) of opioids for cancer pain,

we reviewed the clinical experience of 36 patients who received 46 CIs. CI was always preceded by a period

of repetitive dosing of opioids. Morphine was used in 36 CIs, methadone in four, hydromorphone in four,

oxymorphone in one, and levorphanol in one. Mean doses during CI were the morphine equivalent of 17

mg/hour (range, 0.7-100) at the start, 69 mg/hour (range, 4- 480) at the maximum, and 52 mg/hour (range,

1-480) at termination. Pain relief was acceptable during 28 CIs, unacceptable during 17, and unknown

during one. There were few toxic effects other than sedation. Twenty-five patients died, 12 resumed im or

oral opioids, six continued CI with a different opioid (yielding analgesia in two), and outcome was

undetermined in three. This review suggests that (a) CI is safe, (b) analgesia may require rapid escalation of

infusion rates, (c) patient response varies and lack of acceptable analgesia may occur in up to one-third, (d)

ineffective CI with one drug may be followed by success with another, (e) CI should be preceded by a period

of repetitive iv boluses with the same drug, and (f) guidelines can be developed which incorporate

pharmacokinetic principles AD - Department of Neurology AD - Memorial Sloan-Kettering Cancer Center

AD - New York AD - NY 10021 UI - 86217834

SO - Cancer Treat Rep 1986;70:575-581