Use of opioids in palliative care of children with advanced cancer

Use of opioids in palliative care of children with advanced cancer

Fernandez Urtubia B; Trevigno Bravo A; Rodriguez Zamora N; Palma Torres C; Cid Barria L

Revista Chilena De Pediatria

2016

Advanced Cancer; Childhood Cancer; Opiate/dt [drug Therapy]; Palliative Therapy; 52-26-6 (morphine); 57-27-2 (morphine); 8002-76-4 (opiate); 8008-60-4 (opiate); 53663-61-9 (opiate); Adjuvant; Analgesia; Article; Child; Constipation; Diagnosis; Drug Efficacy; Drug Safety; Female; Human; Major Clinical Study; Male; Medical Record; Morphine; Morphine/dt [drug Therapy]; Nonsteroid Antiinflammatory Agent; Nonsteroid Antiinflammatory Agent/dt [drug Therapy]; Pain/dt [drug Therapy]; Pain Intensity; Retrospective Study; School Child; Sedation; Visual Analog Scale

Introduction Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC). Patients and method Retrospective study of patients admitted into the PC Program at the Hospital Roberto del Rio between 2002 and 2013. Analysis was carried out on demographic data; oncological diagnosis; pain intensity on admission and discharge, according to validated scales; use of non-steroidal anti-inflammatory drugs; weak opioids; strong opioids; adjuvants drugs; the presence of secondary effects resulting from the use of morphine, and the need for palliative sedation. Results Of the 99 medical records analysed, the median age was 8 years, 64.6% were male, and there was a similar distribution in three oncological diagnosis groups. Upon admission, 43.4% presented intense to severe pain, and upon discharge there were four patients, but with a maximum VAS score of 7 in only one case. Of the 66 patients taking strong opioids, 89% required less than 0.5 mg/kg/hr. Constipation was the most frequently observed secondary effect. Conclusions Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe. Copyright _ 2015 Sociedad Chilena de Pediatria. Published por Elsevier Espana.

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