Uso de opiáceos en niños con cáncer avanzado en cuidados paliativos / Use of opioids in palliative care of children with advanced cancer

INTRODUCCIÓN A pesar del avance en el tratamiento del cáncer en pediatría, en Chile el 15% de niños fallece por progresión de la enfermedad, siendo el dolor el síntoma más importante en esta etapa. Las pautas de la OMS demuestran que los opiáceos son fundamentales para controlar el dolor, sin embargo aún existe resistencia a su utilización. OBJETIVO Describir la experiencia en el uso de opiáceos para el manejo del dolor en pacientes pediátricos con cáncer avanzado en cuidados paliativos (CP). PACIENTES Y MÉTODO Estudio retrospectivo de datos registrados en fichas clínicas de pacientes oncológicos ingresados en el Programa de CP, Hospital de Niños Dr. Roberto del Río entre los años 2002 y 2013. Se analizaron datos demográficos, diagnóstico oncológico, intensidad del dolor al ingreso y egreso según escalas validadas. Se registró el uso de antiinflamatorios no esteroideos, opiáceos débiles, opiáceos fuertes, fármacos coadyuvantes, efectos secundarios por uso de morfina y necesidad de sedación paliativa. RESULTADOS Se analizaron 99 fichas médicas, 64,6% de hombres, mediana de 8 años, distribución similar en grupos de enfermedades oncológicas. Al ingreso un 43,4% manifestó de dolor intenso a severo y al egreso solo 4 pacientes, pero con EVA máxima de 7 solo en un caso. De 66 pacientes que utilizaron opiáceos fuertes el 89% requirió menos de 0,5 mg/kg/h de morfina. El estreñimiento fue el efecto secundario más frecuente. Un 77% recibió algún fármaco coadyuvante para el manejo del dolor: 40 utilizaron corticoides, 11 benzodiacepinas y en 25 casos combinación de estos fármacos, incluyendo el uso de gabapentina en 7 casos. CONCLUSIONES Dos tercios de los pacientes requirieron opiáceos fuertes, logrando un adecuado control del dolor, sin observar complicaciones severas. El uso de opiáceos en este grupo de pacientes, siguiendo un protocolo, es efectivo y seguro.

INTRODUCTION Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC). PATIENTS AND METHOD Retrospective study of patients admitted into the PC Program at the Hospital Roberto del Río between 2002 and 2013. Analysis was carried out on demographic data; oncological diagnosis; pain intensity on admission and discharge, according to validated scales; use of non-steroidal anti-inflammatory drugs; weak opioids; strong opioids; adjuvants drugs; the presence of secondary effects resulting from the use of morphine, and the need for palliative sedation. RESULTS Of the 99 medical records analysed, the median age was 8 years, 64.6% were male, and there was a similar distribution in three oncological diagnosis groups. Upon admission, 43.4% presented intense to severe pain, and upon discharge there were four patients, but with a maximum VAS score of 7 in only one case. Of the 66 patients taking strong opioids, 89% required less than 0.5 mg/kg/hr. Constipation was the most frequently observed secondary effect. CONCLUSIONS Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe.

[Use of opioids in palliative care of children with advanced cancer]. / Uso de opiáceos en niños con cáncer avanzado en cuidados paliativos.

INTRODUCTION: Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC). PATIENTS AND METHOD: Retrospective study of patients admitted into the PC Program at the Hospital Roberto del Río between 2002 and 2013. Analysis was carried out on demographic data; oncological diagnosis; pain intensity on admission and discharge, according to validated scales; use of non-steroidal anti-inflammatory drugs; weak opioids; strong opioids; adjuvants drugs; the presence of secondary effects resulting from the use of morphine, and the need for palliative sedation. RESULTS: Of the 99 medical records analysed, the median age was 8 years, 64.6% were male, and there was a similar distribution in three oncological diagnosis groups. Upon admission, 43.4% presented intense to severe pain, and upon discharge there were four patients, but with a maximum VAS score of 7 in only one case. Of the 66 patients taking strong opioids, 89% required less than 0.5mg/kg/hr. Constipation was the most frequently observed secondary effect. CONCLUSIONS: Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe.