Respiratory function during parenteral opioid titration for cancer pain.
BACKGROUND
Respiratory depression is the most feared opioid-related side-effect yet research on the topic is sparse. We evaluated changes in respiratory parameters during parenteral opioid titration for cancer pain to determine if opioid titration was associated with evidence of hypoventilation. The primary outcome measure was to measure changes in end-tidal CO(2) (ET-CO(2)) during opioid titration to pain control.


METHODS
Subjects with severe cancer pain admitted for parenteral opioid titration for poorly controlled pain were eligible. Those who were oxygen dependent were excluded. ET-CO(2), O(2) saturation, respiratory rate (RR), and vital signs were monitored daily until pain control was achieved.


RESULTS
30 patients completed the study of which 29 are reported. The mean ET-CO(2) at initial evaluation was 33.39 -/+ 5.0 and 34.79 -/+ 5.7 mmHg at pain control (P =0.14, 95% CI -0.5 to 3.3). None had an ET-CO(2) > or =50 mmHg. All maintained O(2) saturation > or = 92%. RR dropped transiently below 10/minute in two subjects.


CONCLUSIONS
Parenteral opioid titration for relief of cancer pain was not associated with respiratory depression as demonstrated by significant changes in ET-CO(2) or oxygen saturation in non-oxygen dependent cancer patients.
Estfan
Bassam
B
The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Mahmoud
Fade
F
Shaheen
Philip
P
Davis
Mellar P
MP
Lasheen
Wael
W
Rivera
Nilo
N
Legrand
Susan B
SB
Lagman
Ruth L
RL
Walsh
Declan
D
Rybicki
Lisa
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012131:Respiratory Insufficiency / Q000139:chemically induced*
D000701:Analgesics, Opioid