The trial was conducted at two centers, where 63 patients were randomized to ICE-T or a standard regimen, which at the hospital included 600 mg ibuprofen every 6 hours as needed for pain levels 1-3, one tablet of Percocet (5/325 mg) every 4-6 hours as needed for pain levels 4-6, two tablets of Percocet for pain levels 7-10, and 0.2 mg IV Dilaudid every 3 hours as needed for breakthrough pain
. At-home management consisted of 600 mg ibuprofen every 6 hours for pain levels 1-5 (60 tablets), and Percocet 5 / 325 mg every 6 hours for pain levels 6-10 (16 tablets).
Results: When results of group-B compared with group-A, there was a significant reduction in severity of persistent pain from 5.68 +- 2.08 to 2.83 +- 1.01 (p-value <0.05), breakthrough pain
from 5.90 +- 2.07 to 3.06 +- 1.09 (p-value <0.05).
We hypothesised that the mild to moderate pain in postoperative patients was in fact the breakthrough pain
that occurred between the doses of parenteral analgesia that was given to these patients.
Oral oxycodone is commonly used as a principle opioid; only occasionally is a narcotic PCA pump deemed necessary and rarely are parenteral opioids needed for breakthrough pain
. Acetaminophen and NSAIDs are frequently used when renal and hepatic function are adequate.
When we implemented PIEB into our practice, we retrospectively found that the there was a modest decrease in maximal pain scores experienced by our patients, a slight decrease in unilateral blocks, and a reduction from 19% to 12% of patients requiring manual supplementary boluses of local anesthetics (by the anesthesia team for breakthrough pain
not relieved by the PCEA function of the epidural pumps) (12).
Survival analysis using the Kaplan-Meier survival curves was used to determine the probability of breakthrough pain
between the two randomization arms with accompanying log-rank test to estimate the p value.
We also could evaluate breakthrough pain
intensity by PainVision.
Our study showed that demand-only PCEA without background infusion resulted in less local anaesthetic consumption, the incidence of breakthrough pain
was very minimal and not statistically significant p <0.0675.
Abstral[R] is indicated for the management of breakthrough pain
in cancer patients 18 years of age and older who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain.
Abstral is a fast-acting fentanyl product in EU intended for treatment of breakthrough pain
in cancer patients.
The Sally Hansen Ouch-Relief Wax Strip Kit features what the company is hailing as breakthrough pain
In the case of opioids, an ATC schedule should be supplemented by an oral or IV as needed (PRN) dose order for breakthrough pain
. Patients unable to take oral fluids and medications may be placed on a analgesic pump which provides patient-controlled analgesia (PCA) or nurse-controlled analgesia (NCA).