Abstract:
Opioids and benzodiazepines are cornerstones of the pharmacological management of pain and agitation in palliative medicine. Oral drug delivery is the most popular route of administration, with the subcutaneous route typically utilized where oral medications are not tolerated or are ineffective. Intranasal drug delivery offers an important alternative administration route, with benefits including ease of administration, tolerability and avoidance of needle use, and is particularly useful in the community, where medications may be administered by lay carers or by patients themselves. Intranasal diamorphine and intranasal midazolam both have demonstrated efficacy and safety in adult and pediatric cohorts, however there is limited research into their use in managing pain and agitation in palliative care. We describe the management of three patients under the community palliative care team who received intranasal diamorphine, two of whom also received intranasal midazolam, to manage breakthrough symptoms of pain and agitation at home. In each case, the patient or their relative was taught how to prepare and administer the relevant intranasal medication. This case series demonstrates that for selected patients, diamorphine and midazolam administered intranasally by patients or lay carers at home is efficacious, acceptable and generally well tolerated.
摘要:
阿片类药物和苯二氮卓类药物是姑息治疗中疼痛和激动的药理学管理的基石。口服给药是最流行的给药途径,通常在口服药物不耐受或无效的情况下使用皮下途径。鼻内给药提供了重要的替代给药途径,好处包括易于管理,耐受性和避免使用针头,在社区中特别有用,其中药物可以由外行护理人员或患者自己施用。鼻内二吗啡和鼻内咪达唑仑在成人和儿科队列中均显示出疗效和安全性,然而,在姑息治疗中使用它们来控制疼痛和躁动的研究有限。我们描述了在社区姑息治疗小组下接受鼻内二吗啡的三名患者的管理,其中两人还鼻内接受了咪达唑仑,在家中处理突破性的疼痛和激动症状。在每种情况下,患者或其亲属被教导如何准备和施用相关鼻内药物.本病例系列表明,对于选定的患者,患者或外行护理人员在家中鼻内给予二吗啡和咪达唑仑是有效的,可接受和一般耐受性良好。