RU2234327C2 - Method for treatment of pain syndrome in oncological patients - Google Patents

Abstract

FIELD: medicine, oncology, pharmacy.

SUBSTANCE: invention can be used in treatment of pain syndrome in oncological incurable patients in post-operative period. Method involves application of narcotic analgetics. Autoplasma taken in the amount 100 ml is incubated with narcotic analgetic remedy: 1% morphine or 2% omnoponum in one-half dose - 0.5-1 ml at t = 37 C for 30 min followed by administration by intravenous drop route. Method provides elongation time of analgetic effect, to reduce expression of adverse effects of narcotic analgetics and to improved quality life of patients.

EFFECT: improved method for treatment.

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Description

The invention relates to medicine, namely to oncology, and can be used for the treatment of pain in cancer patients in the postoperative period, anesthetization of incurable patients with the severity of pain on a scale of verbal ratings of 4 points.

The well-known "Method for the treatment of severe pain" (see Mashkovsky M. D. "Medicines", a manual for doctors 2 vol., M., LLC "New Wave", ed. SB Divov, 2001, v.1, p. 147-149), consists in the intramuscular administration of fixed doses of narcotic analgesics (morphine and its analogues) according to a strictly defined scheme or in the appointment as necessary (WHO 1986). A single dose of 1% morphine is 1-2 ml (10-20 mg), the highest daily dose is 5 ml (50 mg), the interval between injections is 4-5 hours, the duration of the effect is 3-5 hours.

In most cases, treatment with opiates gives a good analgesic effect, but is accompanied by various side effects, which often complicate the patient’s already serious condition. Morphine enhances the tone of the smooth muscles of the intestine and causes a spasm of sphincters, which leads to a significant delay in the act of defecation (10-12 hours); as a result of a spasm of the biliary tract and sphincter of Oddi, the pressure in the common bile duct increases by 8-10 times. In 40% of patients, nausea is noted, in 16% of vomiting. Under the influence of morphine in the usual dosage, the stimulating effect of carbon dioxide on the respiratory center decreases by 60-70%, bradypnea, hypoventilation develops, the minute volume of breathing remains reduced for 4-5 hours.

Morphine is contraindicated in weakened and exhausted patients, with cardiovascular pathology and respiratory failure, in old age. All this applies more to patients with oncological pathology.

A characteristic property of opiates is the development of physical and mental dependence on the drug, as well as resistance to them. This is expressed in the fact that after a short time the initial dose is insufficient to obtain proper pain relief, it can increase by tens of times and reach 1-2 g per day and (or) its effect is shortened.

Based on this, the traditional method of using narcotic analgesics cannot be considered optimal from the standpoint of medical, social and economic.

A known method of "Epidural opiatanalgesia in the treatment of pain in cancer patients" (Isakova M.E., Pavlova Z.V., Laktionov KP - M .: Medicine, 1994, 138 p.), We selected as a prototype. The method consists in the epidural administration of morphine 1% at a dose of 0.5 ml. Despite the pronounced and long-lasting analgesic effect in 87.3% of patients, this method is not without the drawbacks of systemic drug therapy. There is a danger of both systemic (resorptive) action and the rostral (to the centers of the medulla oblongata) distribution of the opioid, administered epidurally. This leads to respiratory depression, the development of nausea and vomiting, inhibition of the function of the gastrointestinal tract, and urinary retention. Finally, this method is technically quite complicated, invasive, associated with the danger of infectious and other complications of prolonged catheterization of the epidural space. Moreover, in a cancer patient this method is not always technically feasible due to the impossibility of giving such a patient the necessary body position for puncture.

The aim of the invention is to lengthen the time of the pharmacological action of analgesics and increase the efficiency of their use.

The goal was achieved in that autoplasma in an amount of 100 ml was incubated with a narcotic analgesic (morphine 1% or omnopon 2%) in half dose (0.5-1 ml) at 37 ° C for 30 minutes and was administered intravenously.

The novelty of the invention lies in the fact that autoplasma is used as a medium for intravenous drip administration of narcotic analgesics in doses lower than therapeutic.

The invention "A method for the treatment of pain in cancer patients" is new, since it is unknown from the level of medicine in oncology in the treatment of severe pain in cancer patients in the postoperative period and advanced stages of cancer.

The invention is industrially applicable, as it can be repeatedly reproduced and used in health care, in various general medical institutions and research institutes and oncological dispensaries.

The invention "A method for the treatment of pain in cancer patients" is performed as follows. Autoplasma is obtained from autologous blood taken from the ulnar vein to the Gemakon 500/300 with a stabilizing medium of sodium citrate in a ratio of 1: 4 using discrete plasmopheresis on a PC-06 cruciform centrifuge at 2000 rpm, 20 min, at 22 ° C. 0.5-1 ml of morphine 1% or 0.5-1 ml of omnopon 2% are added to 50-100 ml of plasma, incubated for 30 min at 37 ° C. The resulting preparation is administered intravenously dropwise for 30 minutes.

Examples of specific performance of the "Method for the treatment of pain in cancer patients." Extracts from medical records confirm the clinical effect of the treatment of the proposed method.

Example 1. Patient D., born in 1969, and. No. 17342 / n, was in the intensive care unit of the RNII, on the 2nd day after the operation: pelvic exentation with bladder plastic segment of the small intestine, for locally advanced rectal cancer.

The severity of pain on a scale of verbal assessments was 3-4 points (severe and intolerable pain), the patient was emotionally restless, no sleep, blood pressure 160/100 mm Hg (at normal 120/80 mmHg), tachycardia up to 110 per minute, tachypnea up to 20 per minute.

Anesthesia was carried out with a solution of promedol 2% - 2 ml (40 mg) after 4 hours, the total daily dose was 240 mg with little effect.

After intravenous drip infusion of morphine 1% - 0.5 ml in 100 ml of donor plasma, previously incubated for 30 minutes at 37 ° C, the patient fell asleep after 30 minutes. The duration of complete anesthesia was 8-10 hours. Hemodynamic and respiratory parameters returned to normal: blood pressure 130/80 mmHg, pulse 84 min, respiratory rate 16 min The patient received the next injection of narcotic analgesic after 12 hours.

The patient rated the quality of pain relief as very good.

Example 2. Patient N., born in 1987, and. No. 460, was undergoing palliative treatment in the Department of Pediatric Surgery, RNII with a diagnosis of osteogenic sarcoma of the right iliac bone, with an intralase component that compresses the iliac neurovascular bundle, retroperitoneal metastases.

Complaints of severe girdle pain radiating to the right iliac region, right lower limb, difficulty urinating. The severity of pain on a scale of verbal estimates of 3-4 points (severe and intolerable pain), the degree of activity on the Karnowski scale of 35%.

For pain relief, the patient received intramuscular injections of promedol 2% in a daily dose of up to 8 ml (160 mg) with a satisfactory but short-term effect (no more than 3 hours).

After obtaining autoplasma according to the method described above, intravenous drip infusion of a solution of omnopon 2% - 1 ml in 100 ml of autoplasma was performed for 30 min after preliminary incubation at 37 ° C for 30 min.

The duration of complete anesthesia was 14-16 hours. The next injection of narcotic analgesic after 24 hours. The patient's sleep normalized, self-urination recovered, the degree of physical activity on the Karnowski scale of 80%.

The patient rated the quality of pain relief as very good.

The proposed method is used to treat pain in 16 cancer patients. The average duration of complete analgesia after a single use of this method was 12 hours. In no case was the development of side effects noted.

Improving the results of treatment of pain compared with the traditionally used technique consists in changing the pharmacokinetic properties of narcotic drugs (morphine and its analogues), namely, reducing the distribution of the administered dose and, therefore, longer preserving the therapeutic concentration of the analgesic in the blood.

The technical and economic effectiveness of the “Method for the treatment of pain in cancer patients” consists in lengthening the pharmacological action of morphine and its analogues by 2–3 times compared with the traditional intramuscular route of administration, reducing the severity of side effects and improving the quality of life.

Claims (1)

A method of treating pain in cancer patients using narcotic analgesics, characterized in that autoplasma in an amount of 100 ml is incubated with a narcotic analgesic: morphine 1% or omnopon 2% in a half dose of 0.5-1 ml at t = 37 ° C for 30 minutes and injected intravenously.