Abstract：
Levorphanol is a potent opioid agonist and NMDA receptor blocker with minimal drug interactions, and there are few reports of its use in cancer patients.
We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD).
This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-day. Successful OR was defined as a 2-point improvement in the Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between days 3-10 in patients with uncontrolled pain or resolution of opioid side effects (OSE) in those undergoing OR for OSE alone. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR).
Forty patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication. The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/40 (82.5%) had a successful OR with a median (IQR) ORR of 8.56 (7.5-10). Successful OR was associated with significant improvement in ESAS and OSE scale scores. There was a strong association between MEDD and levorphanol dose.
This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was well- tolerated.
We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD).
This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-day. Successful OR was defined as a 2-point improvement in the Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between days 3-10 in patients with uncontrolled pain or resolution of opioid side effects (OSE) in those undergoing OR for OSE alone. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR).
Forty patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication. The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/40 (82.5%) had a successful OR with a median (IQR) ORR of 8.56 (7.5-10). Successful OR was associated with significant improvement in ESAS and OSE scale scores. There was a strong association between MEDD and levorphanol dose.
This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was well- tolerated.
摘要：
背景：左索啡诺是一种有效的阿片激动剂和NMDA受体阻断剂，具有最小的药物相互作用，在癌症患者中使用它的报道很少。
目的：我们旨在从吗啡当量日剂量（MEDD）确定成功的阿片类药物旋转（OR）到左啡诺的频率和阿片类药物旋转比（ORR）的中位数。
方法：这是一个前瞻性的，单组,介入研究。需要OR并接受60-300mgMEDD的癌症门诊患者以10：1的比例旋转至左啡诺，并每天评估10天。成功的OR被定义为在第10天埃德蒙顿症状评估系统（ESAS）疼痛评分的2点改善，或在第3-10天之间实现个性化疼痛目标。不受控制的疼痛或阿片类药物副作用（OSE）的患者接受或仅接受OSE治疗。使用净MEDD(OR前的MEDD减去与OR后的左啡烷一起使用的穿透阿片样物质的MEDD)计算左啡烷的ORR。
结果：40例患者接受了左索啡诺的OR，不受控制的疼痛35/40（87.5%）是最常见的适应症。净MEDD和左啡诺的中位剂量为95和10毫克，分别,33/40（82.5%）的OR成功，中位数（IQR）ORR为8.56（7.5-10）。成功的OR与ESAS和OSE量表评分的显着改善有关。MEDD和左啡诺剂量之间有很强的相关性。
结论：这项研究提供了初步数据，表明癌症患者可以使用8.5的ORR成功转用左啡诺。左啡诺与改善疼痛和症状控制相关，耐受性良好。
目的：我们旨在从吗啡当量日剂量（MEDD）确定成功的阿片类药物旋转（OR）到左啡诺的频率和阿片类药物旋转比（ORR）的中位数。
方法：这是一个前瞻性的，单组,介入研究。需要OR并接受60-300mgMEDD的癌症门诊患者以10：1的比例旋转至左啡诺，并每天评估10天。成功的OR被定义为在第10天埃德蒙顿症状评估系统（ESAS）疼痛评分的2点改善，或在第3-10天之间实现个性化疼痛目标。不受控制的疼痛或阿片类药物副作用（OSE）的患者接受或仅接受OSE治疗。使用净MEDD(OR前的MEDD减去与OR后的左啡烷一起使用的穿透阿片样物质的MEDD)计算左啡烷的ORR。
结果：40例患者接受了左索啡诺的OR，不受控制的疼痛35/40（87.5%）是最常见的适应症。净MEDD和左啡诺的中位剂量为95和10毫克，分别,33/40（82.5%）的OR成功，中位数（IQR）ORR为8.56（7.5-10）。成功的OR与ESAS和OSE量表评分的显着改善有关。MEDD和左啡诺剂量之间有很强的相关性。
结论：这项研究提供了初步数据，表明癌症患者可以使用8.5的ORR成功转用左啡诺。左啡诺与改善疼痛和症状控制相关，耐受性良好。
