COMPARISON OF HYDROMORPHONE CONTINUOUS SUBCUTANEOUS INFUSION AND BASAL RATE SUBCUTANEOUS INFUSION PLUS PCA IN CANCER PAIN - A PILOT-STUDY

In this pilot randomized, double-blind, cross-over study, the effectiv eness and safety of hydromorphone administration by continuous subcuta neous (s.c.) infusion (mode A) and by continuous basal rate s.c. infus ion + PCA (mode B) were compared in 8 cancer patients. Patients experi mented with each infusion mode during 48 h. Statistical analysis was p erformed on data collected in 7 patients during 36 h from 22:00 h on d ay 1 to 10:00 h on day 3 and from 22:00 h on day 3 to 10:00 h on day 5 . Mean hydromorphone dose +/- S.D. was 56.6 +/- 30.1 and 40.4 +/- 24.5 mg/36 h for modes A and B, respectively. There was no statistically s ignificant difference observed in mean pain intensity, but the absence of significant difference may be related to the small sample size and high individual variability. Both methods provided adequate overall p ain control in most patients. However, a large interindividual variati on was detected. Indeed, some patients reported in the subjective ques tionnaire that they felt marked discomfort during hydromorphone admini stration with mode B. Only 2 patients chose mode B at the end of the s tudy, but it was interesting to note that those 2 patients were the yo ungest of the group. This study demonstrated the effectiveness and saf ety of both modes of hydromorphone administration. The data suggest th at it may be possible to identify particular cancer patients which can really benefit from an association of a basal rate infusion and PCA f or opiate administration.