AW-04. Experience of patient follow-up after withdrawal of opioid analgesics
Konstantin V. Shchedrin, Ekaterina V. Goncharova, Maxim A. Kucher
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Contact: Konstantin V. Shchedrin, e-mail: firstname.lastname@example.org
Current methods of treatment of hematological, malignancy and hereditary diseases may significantly improve overall survival, but at the same time require adequate supportive care, which include pain management. Thrombocytopenia and neutropenia cased by chemotherapy or disease progression represents contraindications to nonsteroidal anti-inflammatory drugs usage. Therefore, in occurrence of mild, moderate or intense pain, tramadol or opioid analgesics often become the options of choice. However, according to duration of the analgesics course and the total dose, after discontinuation of infusion withdrawal syndrome may appear.
Materials and methods
Between 2019 and 2022, 226 episodes of analgesic therapy in children (6 months to 17 years) were analyzed. The main reasons for pain appearance were: mucositis in 65% (n=147), monoclonal antibody therapy – 22.5% (n=51), disease progression – 4% (n=9) and 8.5% (n=19) other reasons. Patients were prescribed tramadol, morphine, fentanyl. Analgesics were administered by prolonged intravenous pump infusion. The average duration was 7.5 days (from 3 to 39 days). Depending on the drug, duration of infusion, and total dose, analgesics were discontinued immediately or with a gradual decrease in the infusion volume as the pain syndrome reduced. The pain management team monitored all patients for the duration of analgesia and 72 hours after its complete withdrawal. Clinical signs of withdrawal were assessed using the WAT-1 scale.
In 15 (6.5%) cases, clinical signs of withdrawal syndrome were observed after the end of analgesic infusion, such as sleep disturbance, irritability, chills without an increase in body temperature. These phenomena were observed in mild form, were managed by the administration of adjuvant medications, did not require resumption of tramadol or opioid infusion and did not affect the duration of hospitalization.
Patients receiving prolonged analgesia with potent drugs and opioid analgesics require additional monitoring during the drug withdrawal phase by pain management team.
Oncohematology, opioid analgetics, withdrawal.