Research Article
Efficacy of Hyaluronidase Preceding Subcutaneous Opioid Infusions for the Treatment of Pain among Hospice Patients
Ronald S. Schonwetter1*, Sehwan Kim1, Mary J. Quinn1, Dee Boehm1, Dipesh Patel2, Cathy Emmett1, Beverly Douglas3, Teresa Kirkland3, Stephen Leedy4, Deidra Woods3 and Anna K. Westmoreland51Chapters Health System, Inc., Temple Terrace, Florida, USA
2Chapters Health Pharmacy, LLC, Tampa, Florida, USA
3LifePath Hospice Inc., Tampa, Florida, USA
4Tidewell Hospice, Sarasota, Florida, USA
5Legacy Meridian Park Medical Center, Tualatin, Oregon, USA
- *Corresponding Author:
- Dr. Ronald S. Schonwetter
Chapters Health System, Inc.,
12973 Telecom Parkway Suite 100
Temple Terrace, FL 33637, USA
Tel: (813) 871-8001
Fax: (813) 383-5044
E-mail: schonwetterr@chaptershealth.org
Received date December 07, 2011; Accepted date January 18, 2012; Published date January 26, 2012
Citation: Schonwetter RS, Kim S, Quinn MJ, Boehm D, Patel D, et al. (2012) Efficacy of Hyaluronidase Preceding Subcutaneous Opioid Infusions for the Treatment of Pain among Hospice Patients. J Palliative Care Med 2:105. doi:10.4172/2165-7386.1000105
Copyright: ©2012 Schonwetter RS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Morphine or hydromorphone are often administered by the subcutaneous (SC) route when oral and/or venous access is difficult to achieve or higher doses of opiates are needed. Human recombinant hyaluronidase is believed to increase the permeability of SC connective tissues by degrading hyaluronan and increasing the dispersion and absorption of coadministered molecules.
Objectives:To determine whether hyaluronidase coadministered with SC morphine or hydromorphone to hospice patients results in 1) faster reduction in pain level; 2) self-perceived pain relief, 3) improved pain-related distress, 4) reduction in the frequency of opiate bolus attempts utilized, and 5) more favorable outcomes on these measures over an eight-hour period.
Methods:This double blind, randomized, placebo-controlled study compared patients given SC hyaluronidase (n=25) and those receiving normal saline (n=29) both immediately prior to SC infusions with morphine or hydromorphone.
Results:Hyaluronidase was found to facilitate reduced pain level (p=0.059) and augmented pain relief (p=0.047) during the first 15 minutes following co-infusion of hyaluronidase when compared to patients in the control group who received usual pain control medication involving SC morphine or hydromorphone. In subsequent periods of observation up to eight hours, the intensity of pain level and the magnitude of pain relief realized showed no difference between the groups. There were no differences between the groups in pain-related distress (p≥0.657) and in the frequency of nfusion bolus attempts during the entire period under observation (p=0.173).
Conclusion: Hyaluronidase may be an effective adjunct during the first 15 minutes of drug administration in reducing pain intensity and enhancing pain relief when administered at the onset of a subcutaneous opioid infusion among hospice patients.
