Patient Controlled Subcutaneous Analgesia of Hydromorphone Versus Morphine to Treat Moderate and Severe Cancer Pain: A Randomized Double-Blind Controlled Trial.

Sep 25, 2023

Experts: Xianzheng Zeng,Jiang Zhu,Jun Li,Chan Chen,Ling Sang,Maotong Liu,Li Song,Hui Liu

Hydromorphone and morphine are the common drugs used for the treatment of moderate to severe cancer pain. Patient controlled subcutaneous analgesia (PCSA) is an effective technique to manage cancer pain. However, few studies have been conducted to show the efficacy and safety of PCSA of hydromorphone for the relief of cancer pain.
To explore the short-term efficacy and safety of PCSA elicited by hydromorphone for moderate to severe cancer pain.
This was a single-center, randomized, active-controlled, double-blind trial (from April 2019 to August 2021). Sixty patients with moderate to severe cancer pain were randomized (1:1) to hydromorphone or morphine groups according to drug delivery by PCSA. The primary outcome was the pain intensity measured by a numerical rating scale (NRS) at 72 h. Secondary outcomes included pain intensity measured by NRS at baseline, 15 min, 30 min, 2 h, 8 h, 24 h and 48 h. The daily occurrence of breakthrough pain (BTP), impact of pain on quality of life measured by the brief pain inventory (BPI), the daily additional consumption of opioids and the incidence of adverse events were also recorded. Adverse events included nausea, vomiting, dizziness, constipation and respiratory depression.
A total of 57 patients (28 patients in the hydromorphone group and 29 patients in the morphine group) in the West China Hospital of Sichuan University were investigated. The mean (standard deviation [SD]) NRS in the two groups at baseline was 7.8 (1.7) in the hydromorphone group and 7.6 (1.7) in the morphine group, and at 72 h were 3.4 (1.8) and 3.2 (1.5), respectively. The postoperative NRS in both groups was decreased significantly compared to baseline. The mean (SD) NRS at 30 min in the hydromorphone group was significantly lower than in the morphine group (3.9 (2.6) vs. 5.3 (2.1), P = 0.035). The daily occurrence of BTP in both groups at 48 h and 72 h decreased significantly compared to the corresponding baseline (P 0.05).
This study found that the PCSA of both hydromorphone and morphine could effectively and safely relieve short-term moderate to severe cancer pain. Of note, the PCSA of hydromorphone took effect more quickly than that of morphine.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Xianzheng Zeng,Jiang Zhu,Jun Li,Chan Chen,Ling Sang,Maotong Liu,Li Song,Hui Liu

Xianzheng Zeng

Department of Pain Management (Z.Z, J.L, Li.S, H.L), West China Hospital, Sichuan University, Chengdu, China.

Jiang Zhu

Department of Thoracic Oncology(J.Z), West China Hospital, Sichuan University, Chengdu, China; Department of Medical Oncology(J.Z), Shangjin Nanfu Hospital, Chengdu, China.

Jun Li

Department of Pain Management (Z.Z, J.L, Li.S, H.L), West China Hospital, Sichuan University, Chengdu, China.

Chan Chen

Department of Anesthesiology (C.C, Ling.S, M.L), West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine(C.C), National-Local Joint Engineering Research Centre of Translational Medicine of nesthesiology(C.C), West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Ling Sang

Department of Anesthesiology (C.C, Ling.S, M.L), West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Maotong Liu

Department of Anesthesiology (C.C, Ling.S, M.L), West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Li Song

Department of Pain Management (Z.Z, J.L, Li.S, H.L), West China Hospital, Sichuan University, Chengdu, China. Electronic address: song_li76@163.com.

Hui Liu

Department of Pain Management (Z.Z, J.L, Li.S, H.L), West China Hospital, Sichuan University, Chengdu, China. Electronic address: 18980601547@qq.com.