Rhythmic pattern of PCA opioid demand in adults with cancer pain.
BACKGROUND
Patient-controlled analgesia (PCA) has an established role in managing postoperative pain and has been successfully used in-patients with cancer pain. The variation of opioid requirement over a 24h period for patients with cancer pain is debated with suggestions of reduced need over night.


METHODS
Retrospective review of 10years (1997-2006) data of all in-patients with cancer pain treated with strong opioids delivered by PCA.


RESULTS
141 patients with cancer pain had a mean cumulative 10day morphine equivalent dose per patient of 671mg (median 470mg; range 10-2170mg). At night (10:01pm to 06:00am) the patient's self administered less bolus doses (69mg, (25%)) than during the other two 8h periods (06:01am to 02:00pm, 91mg (33%) and 02:01pm to 10:00pm, 116mg (42%)). In 8 out of 10days a significant variation in bolus requests was observed with significantly less bolus requests during the night (Friedman test, p<0.05). Furthermore, the median number of delivered bolus requests per patient, at night, was 2-3 compared to the morning and afternoon periods of 3-7 and 3.5-6, respectively.


CONCLUSIONS
PCA met individual patient's opioid needs in a safe and effective manner despite a large inter-individual variability in opioid consumption. Moreover, the study indicated a pattern of less opioid requirement at night.
Schiessl
C
C
Department of Anesthesiology, University Hospital Erlangen, Germany; Center for Palliative Medicine, University Hospital of Cologne, Germany. christine.schiessl@uk-koeln.de
Schestag
I
I
Sittl
R
R
Drake
R
R
Zernikow
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine