ATTENUATION OF MORPHINE-INDUCED DELIRIUM IN PALLIATIVE CARE BY SUBSTITUTION WITH INFUSION OF OXYCODONE

We have observed among patients of the Southern Community Hospice Prog ramme that up to 25% experience acute delirium when treated with morph ine and improve when the opioid is changed to oxycodone or fentanyl. T his study aimed to confirm by a prospective trial that oxycodone produ ces less delirium than morphine in such patients. Oxycodone was admini stered by a continuous subcutaneous infusion, as this allowed more fle xible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statist ically significant improvements in mental state and nausea and vomitin g occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The ph enotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxyc odone administered by the subcutaneous route can provide effective ana lgesia without significant side effects in patients with morphine-indu ced delirium. This treatment allows patients to remain more comfortabl e and lucid in their final days; A smalt proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.