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Rhythmic pattern of PCA opioid demand in adults with cancer pain
European Journal of Pain, 08/12/09

Schiessl C et al. – In a trial to assess the variation of opioid requirement over a 24-hr period for pts with cancer pain, it was ascertained that pt-controlled analgesia (PCA) met individual pt’s opioid needs in a safe and effective manner despite a large inter-individual variability in opioid consumption. The study indicated a pattern of less opioid requirement at night.

• Retrospective review of 10-yrs (1997–2006) data of all in-pts with cancer pain treated with strong opioids delivered by PCA.

• 141 pts with cancer pain had a mean cumulative 10-day morphine equivalent dose per pt of 671 mg (median 470 mg).
• At night (10:01 pm to 06:00 am), the pt’s self-administered less bolus doses (69 mg, [25%]) than during the other 2 8-hr periods (06:01 am to 02:00 pm, 91 mg [33%] and 02:01 pm to 10:00 pm, 116 mg [42%]).
• In 8 of 10 days, a significant variation in bolus requests was observed with significantly less bolus requests during the night.
• Median number of delivered bolus requests per pt at night, was 2–3 vs morning and afternoon periods of 3–7 and 3.5–6, respectively.

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