On butorphanol tartrate nasal spray treatment for radiation 120 cases of oral mucosal inflammatory pain

Radiation oral mucositis in head and neck cancer radiation therapy is the most common side effects one radiation oral mucositis in radiation therapy usually occur after 12 weeks, morning and evening times of large individual differences, often accompanied by mild changes in taste , dry mouth and saliva become sticky. The majority of patients 2 weeks after radiotherapy, altered taste, and the irradiated area was significantly increased mucosal congestion, accompanied by pain. subsequent fibrin, exudate white blood cells to form a point or small pieces pseudomembrane-like, with the gradual formation of pseudomembrane, pain in some patients may have temporary relief, but most patients presented with pain and heavier than before, is limited in patients with eating only soft food or semi-liquid into. radiotherapy or 56 weeks much earlier time, large areas of pseudomembrane formation, dry mouth and throat pain got worse, this time, patients with eating difficulties caused the pain, and often need to give aggressive treatment.

Butorphanol is the opioid receptor agonist - antagonist, acting on κ receptors and produce analgesia, pain intensity 58 times higher than that of morphine, the opioid receptor antagonist with weak nature, inhibit the occurrence of nausea and vomiting, static Note onset after 1min, 45min to reach peak [1]. butorphanol tartrate nasal spray is a new analgesic drug formulations, by nasal spray drug delivery methods for pain treatment, is simple, drug rapid absorption, rapid onset of analgesia, etc. I center in January 2005, December 2010, of butorphanol tartrate nasal spray for the treatment of oral mucositis caused by radiation of pain to clinical efficacy and adverse reactions observed be summarized as follows.

1 Materials and Methods
1.1 General Information: Select a total of 120 patients with head and neck cancer patients (malignant tumors were pathologically confirmed, and underwent radiation therapy at a dose of 50Gy-76Gy. Age of 2376 years, mean age 53 years; one male 74, female 46 cases, classified by disease: 76 cases of nasopharyngeal carcinoma, laryngeal cancer, 12 cases of head and neck metastases in 18 cases, 2 cases of pyriform sinus cancer
1.2 Methods: All patients with oral mucositis after radiation using butorphanol tartrate nasal spray pain treatment in about 23 weeks after radiation therapy, pain after pain treatment given butorphanol tartrate nasal spray (trade Name: Snow Yang, Shanghai Pharmaceutical Co., Ltd. Henry, Zhunzi H20046359, 1 spray per day 14, treatment frequency depending on the degree of pain to adjust the total course of treatment is 24 weeks before treatment should be administered nose clean Road, should be administered by hand press and hold the other side of the nasal passages, so full of drug inhalation.

1.3 OUTCOME MEASURES
1.3.1 evaluate the analgesic effect: The average onset time of analgesia: according to pain onset time (the first pain medication to achieve partial remission after the time of the observations to calculate the average onset time of analgesia.

Average analgesia: According to the analgesia (pain relief up to the next part of the pain in a time of observations to calculate the average analgesia.

Pain relief: before and after treatment using visual analogue scales (VAS, 010 points were scored before and after treatment with patient assessment of analgesia. Is divided into five. Does not alleviate: pain before and after spraying, no change; mild, moderate and were relieved: about pain relief, respectively, and (according to VAS score calculation, complete remission: after spraying to pain according to pain relief and calculate the rate of moderate to severe pain relief rate of pain relief while using RTOG acute radiation injury scale disease assessment criteria (see Table 1.

1.3.2 Quality of Life: The Karnofsky (KPS) score, respectively, in the quality of life assessment before and after treatment.

1.3.3 Adverse reactions observed: The common adverse effects such as drowsiness, sedation, excitement, respiratory depression, nausea, vomiting, euphoria, irritability, hallucinations, disorientation disorder, mental disorder and dependence were observed and recorded.


1.4 Statistical analysis: Using SPSS 10.0 statistical software measurement data with the mean + - standard deviation (± S said, count data using X2 test.

2 Results
2.1 average onset time of pain and analgesia: the average time to onset of analgesia 11min (618min, SD = 15.3. Average analgesia 8.3h (4.011.3h, SD = 5.3. Butorphanol tartrate nasal spray administered by nasal spray, fast onset of drug to maintain longer hours, for oral mucositis caused by radiation can quickly relieve pain. Links to free download http://www.hi138.com 2.2 changes the degree of pain: Most patients were relieved of pain after spraying, there is no valid case, the results (see Table 2.


2.3 Quality of Life: Before treatment, all patients the average KPS score of 60 points, 80 points after treatment (SD = 23, all patients treated by spraying pain, quality of life were significantly improved.

2.4 analgesic effects and adverse reactions: All the patients were not due to severe toxicity and withdrawal most common side effects of drowsiness (48 patients, the incidence rate of 40%, dizziness, sedation (34 cases, rate was 28.33%), followed by nausea, vomiting and other gastrointestinal reactions (a total of 22 patients, the incidence rate of 18.33%, euphoria, irritability, hallucinations, disorientation and other rare disorders (a total of 2 cases, the rate 1.67%.

3 Discussion
Butorphanol is an opioid receptor agonist antagonist, has significantly different from other pure opioid agonist pharmacological characteristics were as follows: low-affinity receptor antagonism and some [3], and κ receptor moderate affinity and generate moderate analgesic and anti-chill effect, and δ receptor affinity is very small, and rarely produces a pure opioid role of irritability and anxiety because of its receptor specificity, making breathing butorphanol suppression, decreased gastrointestinal side effects, the risk of addiction were also significantly reduced, in theory, butorphanol in the treatment of moderate pain in the more traditional opioids such as morphine have advantages, and its low incidence of drug dependence, These advantages make butorphanol widely used in the treatment of pain.

The results showed that butorphanol tartrate nasal spray on the oral mucositis caused by radiation has a better analgesic effect of pain, moderate pain relief was more than 96.67%.

Common side effects of butorphanol sedation, nausea and sweating, less common headache, dizziness, floating sensation, drowsiness, confusion, etc. occasionally hallucinations, abnormal dreams, depersonalization and a sense of palpitations, rash. Respiratory depression than morphine light, maximum respiratory depression in adults appeared in more than 4mg dose, its inhibition does not increase with dose increase. naloxone can antagonize the respiratory depression.

Butorphanol tartrate nasal spray for oral mucositis caused by radiation of pain, analgesic effect, adverse reactions, safe and convenient, worthy of clinical application.

References
[1] Bailey PL, Egan TD, Stanley TH.Intravenous opioid anesthetics.In: Miller RD, ed.anesthesia.5th ed.Philadelphia: Churchill Livingstone, 2000,273376.

[2] Yin Wei Bo, Yu Zihao, Xu Guozhen, Hu Yimin editor. Radiation Therapy Oncology (Fourth Edition, Beijing: China Union Medical University, China Union Medical University Press, 2008.2.1350.

[3] Preston PG.Epidural anesthesia with fentany1 and lidocaine for casarean section: Maternal effects and neonatal outcome.Anesthesiology, 1998,68:938. Links to free download http://www.hi138.com