Year 2018 / Volume 25 / Number 6

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Use of major opioids for control of pain in hospitalized patients

Rev. Soc. Esp. Dolor. 2018; 25(6): 318-324 / DOI: 10.20986/resed.2018.3629/2017

Ángela Usarralde Pérez, Manuel Pérez Figueras, Alfonso Vidal Marcos


ABSTRACT

Objectives: Analyze prescription characteristics of major opioids for treatment of pain in hospitalized patients, influence of the epidemiological characteristics of population, to evaluate prescription for clinical services, efficacy of the analgesia, prescription of concomitant drugs and adverse effects secondary to opioid treatment.
Material and methods: A descriptive, retrospective study carried out between March and April 2016 at Alcorcón Foundation University Hospital. It was considered first opioid prescribed during hospital stay, being followed during first five days of treatment or until discontinuation of the same. Patients with opioid prescribing were excluded exclusively in surgical procedures, who did not continue their treatment during their admission. Variables included were sociodemographic, clinical, clinical service, prescription of major opioids and other drugs, pain assessment and adverse effects.
Results: Most commonly prescribed opioids were morphine and fentanyl. Fentanyl and oxycodone were prescribed mainly in mixed pain, morphine in nociceptive pain and pethidine in visceral pain. Most commonly used routes of administration were intravenous and epidural. Most of the patients took other concomitant drugs, being the most frequent paracetamol. The main prescribing services were traumatology, oncology and internal medicine. Fentanyl was mainly based on traumatology and internal medicine, morphine in traumatology and oncology, oxycodone in oncology and pethidine in internal medicine. Pain unit monitored half of patients, especially in surgical patients. Majority of patients had value of the simple numerical scale, with the mean being 2.7. Side effects were mild, emphasizing nausea, vomiting and constipation.
Discussion: Degree of analgesia obtained with opioid treatment was satisfactory, with an acceptable value. Side effects were mild, with prominent opioid nausea, vomiting and constipation. Prescription of major opioids followed the usual pattern of use in hospital setting. This type of study allows to know and compare use of opioids between clinical services and hospitals, as well as predicting needs and recognizing inefficiencies.



RESUMEN

Objetivos: Analizar las características de prescripción de opioides mayores para el tratamiento del dolor en pacientes hospitalizados. Evaluar la influencia de las características epidemiológicas de la población, la prescripción por servicios clínicos, la eficacia de la analgesia pautada, la prescripción de fármacos concomitantes y los efectos adversos secundarios al tratamiento opioide.
Material y métodos: Estudio descriptivo, retrospectivo realizado entre marzo y abril de 2016 en el Hospital Universitario Fundación Alcorcón. Se consideró el primer opioide prescrito durante la estancia hospitalaria, haciéndose un seguimiento durante los cinco primeros días de tratamiento o hasta la discontinuación de este. Se excluyeron pacientes con prescripción de opioides en procedimientos quirúrgicos exclusivamente, que no continuaron con el tratamiento de los mismos durante su ingreso. Las variables recogidas fueron: sociodemográficas, clínicas, servicio clínico, prescripción de opioides mayores y otros fármacos, valoración del dolor y efectos adversos.
Resultados: Los opioides más prescritos fueron morfina y fentanilo. Fentanilo y oxicodona se prescribieron principalmente en dolor mixto, morfina en dolor nociceptivo y petidina en dolor visceral. Las vías de administración más usadas fueron intravenosa y epidural. La mayoría de los pacientes tomaron otros fármacos concomitantes, siendo el más frecuente paracetamol. Los principales servicios prescriptores fueron traumatología, oncología y medicina interna. Fentanilo se pautó principalmente en traumatología y medicina interna, morfina en traumatología y oncología, oxicodona en oncología y petidina en medicina interna. La unidad del dolor realizó seguimiento de la mitad de los pacientes, especialmente en pacientes quirúrgicos. La mayoría
de los pacientes tenían registrado el valor de la escala numérica simple, siendo la media 2,7. Los efectos secundarios fueron leves, destacando náuseas, vómitos y estreñimiento.
Discusión: El grado de analgesia conseguido con el tratamiento opioide fue satisfactorio, con un valor aceptable. Los efectos secundarios fueron porcentualmente leves, destacando las náuseas, los vómitos y el estreñimiento propios de los opioides. La prescripción de opioides mayores siguió el patrón habitual de utilización en el ámbito hospitalario. Este tipo de estudios permite conocer y comparar el uso de opioides entre servicios clínicos y hospitales, así como predecir necesidades y reconocer ineficiencias.


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Instrucciones para citar

Usarralde Pérez Á, Pérez Figueras M, Vidal Marcos A. Use of major opioids for control of pain in hospitalized patients. Rev Soc Esp Dolor 2018; 25(6): 318-324 / DOI: 1020986/resed20183629/2017


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Recibido: 25/10/2017

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