R08 - Occasional sedation in the management of cancer pain

Abstract

Background: Palliative sedation is an intentional reduction of the patient's awareness until the lost consciousness. It is used at the end of life to relieve severe and refractory symptoms in patients with advance stage of disease. Occasional sedation (OS) is not consider a type of palliative sedation. It reduces the patient's consciousness for a brief period and provides the patient awakining by discontinuing sedative medications. It can be used for invasive nursing actions or to give rest in patient with anxiety or insomnia. A very few licterature data exist for the use of OS in the management of cancer pain at the end of life. Material (patients) and methods: A retrospective analysis of patients with advanced cancer admitted to hospice from April 2015 to April 2106 was performed. The OS was proposed to patients with severe pain due to a particular trigger event when the use of opioids was not sufficient to control pain. Informations about epidemiologic and clinical characteristics, indications, duration, drugs, and outcomes was collected. Results: 266 patients entered the Hospice consecutively during the year. OS was offered to 6 cases with patient's consent. All of them received high doses of opioids for background pain. Indications for OS were: pain control during every dressing of large neoplastic lesions (n= 2) or pressure sores (n = 1), pain control during painful nursing cares (n = 2), pain and anxiey control every night (n= 1).The OS was carried out in all cases through intravenous administration of Midazolam (dose range 5 mg - 70 mg ) and Morphine. Duration of OS depended on desiderated time of awaking (range 1 hour -12 hours). In 2 of the 6 cases Flumazenil (0,1 mg i.v.) was used to awaken the patient with immediate effect. Conclusions: Pain can have high physical and emotional impact in the patient with advanced cancer. If opioids are not sufficient to control pain due to trigger events, OS can be considered. The OS is useful in complex dressings, painful nursing care practices and to control pain and anxiety overnight. The use of Flumazenil should always be considered to awaken the patient when the triggering pain is over.