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Intranasales Fentanyl zur Therapie akuter Schmerzspitzen bei Karzinompatienten

Intranasal fentanyl for breakthrough cancer pain. A pilot study

Eine Pilotstudie

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Zusammenfassung

Ein hoher Prozentsatz der Patienten mit chronischen Tumorschmerzen klagt trotz regelmäßiger Analgetikagabe über intermittierend auftretende akute Schmerzspitzen. Wegen solcher Schmerzspitzen muß bei Patienten mit chronischen Karzinomschmerzen neben einer Basisanalgesie (mit z.B. retardiertem Morphin oder Buprenorphin) zusätzlich eine Bedarfsmedikation verordnet werden. In der vorliegenden Studie wurde bei fünf Patienten zur Therapie einer akuten Schmerzspitze eine intranasale, bedarfsadaptierte Fentanyltitration durchgeführt. Bei allen Patienten konnte damit eine schnell einsetzende und deutliche Schmerzreduktion erzeilt werden. Klinisch relevante Veränderungen von arterieller Sauerstoffsättigung, Herzfrequenz, Blutdruck oder Atemfrequenz traten nicht auf. Alle Patienten beurteilten die erzielte Schmerzlinderung als gut oder sehr gut. Schmerzen oder Brennen im Bereich der Nase wurden von keinem Patienten angegeben.

Abstract

Background and aim of the study

Despite regular administration of analgesics, a high percentage of patients with chronic malignant pain experience break-through cancer pain or incident pain. Such pain peaks in patients with chronic malignant pain require “rescue” medication in addition to basic analgesia with for example slow-release morphine or buprenorphine. For rescue medication a fast acting and powerful analgesic should be available to the patient. Recent studies have shown that intranasal fentanyl provides rapid onset of pain relief.

Patients and methods

In this open pilot study five patients with chronic cancer pain (age: 42–62 years; weight: 55–80 kg) received demand-adapted intranasal fentanyl titration for treatment of acute breakthrough cancer pain. Intranasal fentanyl doses (0.027 mg) were repeated at 5-min intervals until the patients experienced marked pain relief. Pain intensity was evaluated (0–30 min: 5-min intervals; 30–120 min: 10-min intervals) with the aid of a numerical rating scale (0 = no pain; 100 worst pain possible).

Results and discussion

The patients received 2, 4, 6, 7 or 8 fentanyl boluses (totalling 0.054 mg, 0.108 mg, 0.162 mg, 0.189 mg or 0.216 mg, respectively). Rapid onset and marked reduction of pain intensity was achieved in all five patients. There were no clinically relevant changes in arterial haemoglobin oxygen saturation, heart rate, arterial blood pressure or respiratory rate. All five patients scored the pain relief obtained as good or very good. There were no reports of pain or burning sensations in the nose or other side-effects.

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Striebel, H.W., Wessel, A. & Rieger, A. Intranasales Fentanyl zur Therapie akuter Schmerzspitzen bei Karzinompatienten. Schmerz 7, 174–177 (1993). https://doi.org/10.1007/BF02530425

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