Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study

  • Saeed Majidinejad Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. http://orcid.org/0000-0002-2985-5104
  • Mahdi Ebrahimi Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Farhad Heydari Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-6296-0045
  • Mahdi Ahmadpour Emergency Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mehrdad Esmailian Emergency Medicine Research Center, Department of Emergency Medicine, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. https://orcid.org/0000-0002-3510-4462
Keywords: Cancer Pain, Fentanyl, Methadone, Morphine, Nebulizers and Vaporizers, Pain Management, Transdermal Patch

Abstract

Introduction: Recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy. Objective: This study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients. Method: This double-blind, randomized controlled study conducted between April and September 2017. Ninety eligible cancer patients presenting to Sayed al-Shohada Hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. Pain severity was scored by Visual Analog Scale (VAS). Patients were followed up for 3 days and then data were analyzed by SPSS. The benchmark of success was set as marking 4 or below on VAS and a reduction ratio of 50 percent. Results: Pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6-10) at baseline to 2.46 (range 1-4) at the end of the 3rd day in the nebulized group. The decrease ratio was equal to 70.8% after three days (p<0.05). Pain severity reduced from 8.45 (range 7-10) to 1.8 (range 1-3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6-10) to 2.13 (range 1-3) in the fentanyl group. Conclusion: Our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer.

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Published
2019-04-30
How to Cite
Majidinejad, S., Ebrahimi, M., Heydari, F., Ahmadpour, M., & Esmailian, M. (2019). Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study. Advanced Journal of Emergency Medicine, 3(3), e23. https://doi.org/10.22114/ajem.v0i0.129
Section
Original article