Una alternativa al tratamiento con fentanilo: la morfina

Objectives: a) to know the pain control level at the end of 24-72 hours when the treatment with fentanyl is replaced by morphine; b) to know if it really exists any difficulty to adjust the opioid just dose on the transdermic fentanyl removed; and c) to evaluate the value of the equivalence between these two medicines according to the fentanyl TTS prospectus. Material and method: observational prospective study. Inclusion criteria: older than 18 years; advanced cancer; fentanyl removed; patients sent to palliative care. Variables: age, sex, type of pain, cause of changing, alternative opioid, fentanyl dose, initial morphine dose and after 72 hours, EVA (analogical visual scale) of pain with fentanyl, EVA with initial morphine and KPS after 72 hours. Results: twenty-nine patients. Average age: 62.75 years. Type of pain: physical 37.9%, visceral 20.7%, mixed 37.9% and neurophatic 3.4%. The change cause in a 89.7% was the bad control of pain. The alternative opioid was the morphine in a 86.2% and the methadone in a 13.8%. Subcutaneous tracts in a 62.1%, oral tracts in a 37.9%. The average dose of fentanyl was 77.16 pg. The initial average dose of morphine in a day was 42.07 mg and the average dose after 72 hours was 42.32 mg. The EVA average of pain with fentanyl was 71.52/100. The initial EVA average with morphine was 21.28/100 and after 72 hours it was 18.25/100. Conclusions: according to our results: a) the change from fentanyl to morphine achieves the optimal pain control; b) after opioid changing the morphine analgesic doses keep steady without problems to adjuste the dose; and c) in line with our results, the equivalence between fentanyl and morphine does not correspond to the fentanyl TTS prospectus.