Comparison of parenteral fentanyl and morphine infusion in chronic cancer pain management: Parenteral opioid treatment for cancer pain.

BACKGROUND

The World Health Organization pain ladder treatment is recognized as the gold standard for moderate and severe chronic cancer pain palliation in hospitalized patients. The third step of this treatment includes powerful opioid agents, which in our case are morphine and fentanyl.

METHODS

The primary purpose of our study is to measure pain symptom relief by evaluating the pain scores after intravenous continuous infusion of these opioids in palliative care unit to ensure pain control of the patients. Our second main goal is to compare the morphine equivalent dose (MED) administered to both groups within 72 hours. Our study aimed to compare the frequency of side effects in both groups within 72 hours. The prospective observational study included 67 patients, who included inclusion and exclusion criteria. In respect of the opioid being infused, patients were distributed into Fentanyl (n = 33) and Morphine (n = 34) groups. Patients who were admitted to the palliative care unit were administered a continuous intravenous infusion of morphine or fentanyl. Continuous infusion was administered for 3 days in the hospital. An elastomeric intravenous pump was used for infusion. Taking into account the opioid agents and their doses, consumed by the patient prior to hospital admission, equal doses were calculated for both fentanyl and morphine consumers. For the management of breakthrough pain, 5-15 percent of the daily opioid dose was administered in both groups. Daily pain scores, breakthrough pain scores, basal infusion doses, breakthrough pain doses, laboratory tests, and hemodynamic parameters of the patients were recorded.

RESULTS

Total opioid dose as well as MED and visual analogue scale/numerical rating scale (VAS/NRS) reduction was statistically lower in the fentanyl group (p: 0.000; p < 0.05). There was no significant difference in terms of adverse effects.

CONCLUSION

The study demonstrates that the total consumption of opioids is approximately 70 times higher in the morphine group. The total MED in the fentanyl group is seven times lower than that in the morphine group. Thus, we suggest parenteral administration of fentanyl as a more advantageous alternative to morphine, and we believe that larger, randomized prospective research studies should be conducted on this subject.