COMPARISON OF A PATIENT-CONTROLLED ANALGESIA SYSTEM WITH CONTINUOUS-INFUSION FOR ADMINISTRATION OF DIAMORPHINE FOR MUCOSITIS

Mucositis remains an important problem following BMT and may delay dis charge from hospital. Patient-controlled analgesia (PCA) systems have been reported to be of benefit in controlling BMT-associated mucositis , The present study comprised 65 patients (age range 16-68 years; 19 a llografts, 29 peripheral blood stem cell autografts and 17 autologous bone marrow), Subjects were prospectively randomised to receive intrav enous diamorphine for pain relief either by conventional continuous in fusion (CI) or by PCA, using a Medex Walkman 440 delivery system. Each patient assessed his/her pain control and nausea daily by a visual an alogue scale. Twenty-two patients did not require any diamorphine, Fou r patients required diamorphine for pain other than mucositis, and fou r patients failed PCA control, Of 35 assessable cases, no difference i n pain control was noted between CI and PCA, However, PCA-controlled p atients required significantly less diamorphine than CI controlled pat ients (mean, 131 +/- 23 mg for PCA vs 296 +/- 40 mg for CI; P = 0.001) , and PCA required fewer days of diamorphine than CI (mean, 7.17 +/- 0 .66 days for PCA, 9.00 +/- 0.65 days for CI; P = 0.03). Side-effects w ere minimal and equivalent in the two arms. The findings suggest that PCA and CI offer equivalent control of the pain of BMT-associated muco sitis, but PCA requires less total consumption and duration of diamorp hine therapy.