Managing breakthrough pain for advanced malignancy in elderly patients: A real challenge

Deepti Ahuja, MD; Nandan Choudhary, MD; Vinod Kumar, MD; Nishkarsh Gupta, MD; Sachidanand Jee Bharati, DM

doi:10.5055/jom.2020.0571

Authors

Deepti Ahuja, MD
Nandan Choudhary, MD
Vinod Kumar, MD
Nishkarsh Gupta, MD
Sachidanand Jee Bharati, DM

DOI:

https://doi.org/10.5055/jom.2020.0571

Keywords:

elderly, lung cancer, COPD, renal impairment, hypoproteinemia, opioid, toxicity, naloxone

Abstract

Pain management in advanced cancer patients using opioids like morphine is challenging due to presence of predisposing factors like renal insufficiency, hepatic insufficiency, hypoproteinemia, hypoalbuminemia, and anemia that can easily precipitate inadvertent toxic effects. We report a case morphine toxicity in an elderly patient of lung cancer with concomitant presence of chronic obstructive pulmonary disease (COPD) and recent onset renal impairment. Opioid analgesic overdose is a lethal but at the same time, a preventable and treatable condition. We managed the case using naloxone infusion. However, we emphasize early anticipation and recognition of predisposing factors followed by timely intervention to manage this life-threatening condition.

Author Biographies

Deepti Ahuja, MD

Senior Resident, Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India

Nandan Choudhary, MD

Junior Resident, Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India

Vinod Kumar, MD

Additional Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India

Nishkarsh Gupta, MD

Additional Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India

Sachidanand Jee Bharati, DM

Additional Professor, Department of Onco-Anaesthesia and Palliative medicine, Dr B.R.A.I.R.C.H, All India Institute of Medical Sciences, New Delhi, India

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