Opioid Switching: a Descriptive Analysis
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Revista Brasileira de Cancerologia (Online) |
Texto Completo: | https://rbc.inca.gov.br/index.php/revista/article/view/1179 |
Resumo: | Introduction: The use of opioids must be individualized and changing for another opioid may be necessary (opioid switching). Objective: Identify how the opioid switching was performed and whether the desired effect was achieved in patients admitted at a public palliative oncologic care specialized hospital. Method: Post hoc analysis of the profile study of patients admitted to a public oncologic palliative care hospital in Rio de Janeiro between September and November 2016. Hospitalizations were followed longitudinally by reviewing the charts with daily collection of the numeric rating scale (NRS). Pain was considered controlled when NRS = 0. Doses, route of administration, switch (drugs and motif ) of the opioids were observed. The time for pain control was calculated when this was the reason. Results: 104 opioid switching were observed in 90 hospitalizations (22.5%), 49% of which were strong opioids and 43%, from mild to strong. Main reasons were pain (40%) and dyspnea (36%). The time to NRS = 0 was 1.6 days (+/-1.8; 95% CI 1.0-2.1), taking longer to switch to methadone (mean 2.7 days +/-2.5; 95% CI 1.0-4.4). Comparing the dose of oral morphine by analgesic equipotency, a 10% increase in the target opioid dose occurred, and when rotating due to dyspnea (38%), the increase was greater. Conclusion: Although pain control was higher tan described in other studies, the increase in the equipotent dose of opioid is not corroborated by protocols. Extensive surveillance and other studies are recommended in the unit. |
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Opioid Switching: a Descriptive AnalysisRotación de Opioides: un Análisis DescriptivoRodízio de Opioides: uma Análise DescritivaCuidados PaliativosManejo da DorAnalgésicos Opioides/administração & dosagemConduta do Tratamento MedicamentosoPalliative CarePain ManagementAnalgesics, Opioid/ administration & dosageMedication Therapy ManagementCuidados PaliativosManejo del DolorAnalgésicos Opioides/administración & dosificaciónAdministración del Tratamiento FarmacológicoIntroduction: The use of opioids must be individualized and changing for another opioid may be necessary (opioid switching). Objective: Identify how the opioid switching was performed and whether the desired effect was achieved in patients admitted at a public palliative oncologic care specialized hospital. Method: Post hoc analysis of the profile study of patients admitted to a public oncologic palliative care hospital in Rio de Janeiro between September and November 2016. Hospitalizations were followed longitudinally by reviewing the charts with daily collection of the numeric rating scale (NRS). Pain was considered controlled when NRS = 0. Doses, route of administration, switch (drugs and motif ) of the opioids were observed. The time for pain control was calculated when this was the reason. Results: 104 opioid switching were observed in 90 hospitalizations (22.5%), 49% of which were strong opioids and 43%, from mild to strong. Main reasons were pain (40%) and dyspnea (36%). The time to NRS = 0 was 1.6 days (+/-1.8; 95% CI 1.0-2.1), taking longer to switch to methadone (mean 2.7 days +/-2.5; 95% CI 1.0-4.4). Comparing the dose of oral morphine by analgesic equipotency, a 10% increase in the target opioid dose occurred, and when rotating due to dyspnea (38%), the increase was greater. Conclusion: Although pain control was higher tan described in other studies, the increase in the equipotent dose of opioid is not corroborated by protocols. Extensive surveillance and other studies are recommended in the unit.Introducción: El uso de opioides debe ser individualizado y puede ser necesario cambiarlo por otro opioide (rotación de opioides). Objetivo: Identificar cómo se realizó la rotación de opioides y si el efecto deseado se logró en pacientes ingresados en una unidad especializada en cuidados oncológicos paliativos. Método: Análisis post hoc del estudio de perfil de pacientes ingresados en un hospital público de cuidados paliativos de oncología en Río de Janeiro, entre septiembre y noviembre de 2016. Las hospitalizaciones fueron seguidas longitudinalmente mediante la revisión de los registros médicos con la recopilación diaria de la Escala Numérica Verbal (ENV). El dolor se consideró controlado cuando ENV = 0. Se observaron dosis, vía de administración, rotación (fármacos y motivo) de los opioides. El tiempo para el control del dolor se calculó cuando esta fue la razón. Resultados: Se observaron 104 ruedas de opioides en 90 hospitalizaciones (22,5%), con 49% entre opioides fuertes y 43% de débiles a fuertes. Las razones principales fueron dolor (40%) y disnea (36%). El tiempo para ENV = 0 fue de 1,6 días (+/-1,8; IC del 95%: 1,0-2,1), y tomó más tiempo cambiar a metadona (promedio 2,7 días +/-2,5; IC 95% 1,0-4,4). Comparando la dosis de morfina oral para la equipotencia analgésica, hubo un aumento del 10% en la dosis de opioides objetivos, este aumento fue mayor al rotar debido a la disnea (38%). Conclusión: Aunque el control del dolor fue superior al descrito por otros estudios, el aumento en la dosis equipotente de opioide no es compatible con los protocolos. Se recomienda mayor vigilancia y otros estudios en la unidad.Introdução: O uso de opioides deve ser individualizado e a troca por outro opioide pode ser necessária (rodízio de opioide). Objetivo: Identificar como foi realizado o rodízio de opioide e se o efeito desejado foi atingido em pacientes internados em uma unidade especializada em cuidados paliativos oncológicos. Método: Análise post hoc do estudo de perfil de pacientes internados em um hospital público de cuidados paliativos oncológicos no Rio de Janeiro, entre setembro e novembro de 2016. As internações foram acompanhadas longitudinalmente por revisão de prontuário com coleta diária da escala verbal numérica (EVN). A dor foi considerada controlada quando EVN = 0. Doses, via de administração e rodízio (fármaco e motivo) dos opioides foram observados. O tempo para controle da dor foi calculado quando este foi o motivo. Resultados: Foram observados 104 rodízios de opioides em 90 internações (22,5%), sendo 49% entre opioides fortes e 43% de fraco para forte. Principais motivos foram dor (40%) e dispneia (36%). O tempo para EVN = 0 foi 1,6 dias (+/-1,8; IC95% 1,0-2,1), sendo mais demorado na troca por metadona (média 2,7 dias +/-2,5; IC95% 1,0-4,4). Comparando a dose de morfina oral por equipotência analgésica, houve aumento de 10% na dose do opioide de destino, sendo esse aumento maior quando no rodízio por dispneia (38%). Conclusão: Embora o controle de dor tenha sido superior ao descrito por outros trabalhos, o aumento da dose equipotente do opioide não é corroborado por protocolos. Maior vigilância e outros estudos são recomendados na unidade.INCA2021-02-22info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionArtigos, Avaliado pelos paresapplication/pdfapplication/pdfhttps://rbc.inca.gov.br/index.php/revista/article/view/117910.32635/2176-9745.RBC.2021v67n2.1179Revista Brasileira de Cancerologia; Vol. 67 No. 2 (2021): Apr./May/June; e-011179Revista Brasileira de Cancerologia; Vol. 67 Núm. 2 (2021): abr./mayo/jun.; e-011179Revista Brasileira de Cancerologia; v. 67 n. 2 (2021): abr./maio/jun.; e-0111792176-9745reponame:Revista Brasileira de Cancerologia (Online)instname:Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)instacron:INCAporenghttps://rbc.inca.gov.br/index.php/revista/article/view/1179/939https://rbc.inca.gov.br/index.php/revista/article/view/1179/1350Copyright (c) 2021 Revista Brasileira de Cancerologiainfo:eu-repo/semantics/openAccessSampaio, Simone Garruth dos Santos MachadoMotta, Luciana Branco daCaldas, Célia Pereira 2021-11-29T18:27:39Zoai:rbc.inca.gov.br:article/1179Revistahttps://rbc.inca.gov.br/index.php/revistaPUBhttps://rbc.inca.gov.br/index.php/revista/oairbc@inca.gov.br0034-71162176-9745opendoar:2021-11-29T18:27:39Revista Brasileira de Cancerologia (Online) - Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA)false |
dc.title.none.fl_str_mv |
Opioid Switching: a Descriptive Analysis Rotación de Opioides: un Análisis Descriptivo Rodízio de Opioides: uma Análise Descritiva |
title |
Opioid Switching: a Descriptive Analysis |
spellingShingle |
Opioid Switching: a Descriptive Analysis Sampaio, Simone Garruth dos Santos Machado Cuidados Paliativos Manejo da Dor Analgésicos Opioides/administração & dosagem Conduta do Tratamento Medicamentoso Palliative Care Pain Management Analgesics, Opioid/ administration & dosage Medication Therapy Management Cuidados Paliativos Manejo del Dolor Analgésicos Opioides/administración & dosificación Administración del Tratamiento Farmacológico |
title_short |
Opioid Switching: a Descriptive Analysis |
title_full |
Opioid Switching: a Descriptive Analysis |
title_fullStr |
Opioid Switching: a Descriptive Analysis |
title_full_unstemmed |
Opioid Switching: a Descriptive Analysis |
title_sort |
Opioid Switching: a Descriptive Analysis |
author |
Sampaio, Simone Garruth dos Santos Machado |
author_facet |
Sampaio, Simone Garruth dos Santos Machado Motta, Luciana Branco da Caldas, Célia Pereira |
author_role |
author |
author2 |
Motta, Luciana Branco da Caldas, Célia Pereira |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Sampaio, Simone Garruth dos Santos Machado Motta, Luciana Branco da Caldas, Célia Pereira |
dc.subject.por.fl_str_mv |
Cuidados Paliativos Manejo da Dor Analgésicos Opioides/administração & dosagem Conduta do Tratamento Medicamentoso Palliative Care Pain Management Analgesics, Opioid/ administration & dosage Medication Therapy Management Cuidados Paliativos Manejo del Dolor Analgésicos Opioides/administración & dosificación Administración del Tratamiento Farmacológico |
topic |
Cuidados Paliativos Manejo da Dor Analgésicos Opioides/administração & dosagem Conduta do Tratamento Medicamentoso Palliative Care Pain Management Analgesics, Opioid/ administration & dosage Medication Therapy Management Cuidados Paliativos Manejo del Dolor Analgésicos Opioides/administración & dosificación Administración del Tratamiento Farmacológico |
description |
Introduction: The use of opioids must be individualized and changing for another opioid may be necessary (opioid switching). Objective: Identify how the opioid switching was performed and whether the desired effect was achieved in patients admitted at a public palliative oncologic care specialized hospital. Method: Post hoc analysis of the profile study of patients admitted to a public oncologic palliative care hospital in Rio de Janeiro between September and November 2016. Hospitalizations were followed longitudinally by reviewing the charts with daily collection of the numeric rating scale (NRS). Pain was considered controlled when NRS = 0. Doses, route of administration, switch (drugs and motif ) of the opioids were observed. The time for pain control was calculated when this was the reason. Results: 104 opioid switching were observed in 90 hospitalizations (22.5%), 49% of which were strong opioids and 43%, from mild to strong. Main reasons were pain (40%) and dyspnea (36%). The time to NRS = 0 was 1.6 days (+/-1.8; 95% CI 1.0-2.1), taking longer to switch to methadone (mean 2.7 days +/-2.5; 95% CI 1.0-4.4). Comparing the dose of oral morphine by analgesic equipotency, a 10% increase in the target opioid dose occurred, and when rotating due to dyspnea (38%), the increase was greater. Conclusion: Although pain control was higher tan described in other studies, the increase in the equipotent dose of opioid is not corroborated by protocols. Extensive surveillance and other studies are recommended in the unit. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-02-22 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Artigos, Avaliado pelos pares |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://rbc.inca.gov.br/index.php/revista/article/view/1179 10.32635/2176-9745.RBC.2021v67n2.1179 |
url |
https://rbc.inca.gov.br/index.php/revista/article/view/1179 |
identifier_str_mv |
10.32635/2176-9745.RBC.2021v67n2.1179 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://rbc.inca.gov.br/index.php/revista/article/view/1179/939 https://rbc.inca.gov.br/index.php/revista/article/view/1179/1350 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Revista Brasileira de Cancerologia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Revista Brasileira de Cancerologia |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
INCA |
publisher.none.fl_str_mv |
INCA |
dc.source.none.fl_str_mv |
Revista Brasileira de Cancerologia; Vol. 67 No. 2 (2021): Apr./May/June; e-011179 Revista Brasileira de Cancerologia; Vol. 67 Núm. 2 (2021): abr./mayo/jun.; e-011179 Revista Brasileira de Cancerologia; v. 67 n. 2 (2021): abr./maio/jun.; e-011179 2176-9745 reponame:Revista Brasileira de Cancerologia (Online) instname:Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) instacron:INCA |
instname_str |
Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) |
instacron_str |
INCA |
institution |
INCA |
reponame_str |
Revista Brasileira de Cancerologia (Online) |
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Revista Brasileira de Cancerologia (Online) |
repository.name.fl_str_mv |
Revista Brasileira de Cancerologia (Online) - Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) |
repository.mail.fl_str_mv |
rbc@inca.gov.br |
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