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Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation

Blood Research 2020년 55권 3호 p.151 ~ 158
오현진, 홍소연, 전영미, 최경숙, 이은숙, 이은이, 김유정, 방수미,
소속 상세정보
오현진 ( Oh Hyun-Jin ) - Seoul National University Bundang Hospital Department of Pharmacy
홍소연 ( Hong So-Yeon ) - Seoul National University Bundang Hospital Department of Pharmacy
전영미 ( Jeong Young-Mi ) - Seoul National University Bundang Hospital Department of Pharmacy
최경숙 ( Choi Kyung-Suk ) - Seoul National University Bundang Hospital Department of Pharmacy
이은숙 ( Lee Eun-Sook ) - Seoul National University Bundang Hospital Department of Pharmacy
이은이 ( Lee Eun-I ) - Seoul National University College of Pharmacy
김유정 ( Kim Yu-Jung ) - Seoul National University Bundang Hospital Department of Internal Medicine
방수미 ( Bang Soo-Mee ) - Seoul National University Bundang Hospital Department of Internal Medicine

Abstract


Background: Hematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients’ quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies.

Methods: A retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4?10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines.

Results: In total, 119 cases were evaluated, including 369 episodes of moderate to severe pain. Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids.

Conclusion: Short-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients. Pain management guidelines specific for HSCT patients should be developed in the future.

키워드

Hematopoietic stem cell transplantation; Opioid; Analgesics; Pain management

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