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Palliative Medicine, Vol. 21, No. 2, 81-86 (2007)
DOI: 10.1177/0269216307077328

Respiratory function during parenteral opioid titration for cancer pain

Bassam Estfan

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Fade Mahmoud

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Philip Shaheen

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Mellar P Davis

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Wael Lasheen

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Nilo Rivera

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Susan B LeGrand

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Ruth L Lagman

The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center

Declan Walsh

Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, walsht{at}ccf.org

Lisa Rybicki

Department of Quantitative Health Sciences, The Cleveland Clinic Foundation

Background: Respiratory depression is the most feared opioid-related side-effect yet research on the topic is sparse. We evaluated changes in respiratory parameters during parenteral opioid titration for cancer pain to determine if opioid titration was associated with evidence of hypoventilation. The primary outcome measure was to measure changes in end-tidal CO2 (ET-CO2) during opioid titration to pain control.

Methods: Subjects with severe cancer pain admitted for parenteral opioid titration for poorly controlled pain were eligible. Those who were oxygen dependent were excluded. ET-CO2, O2 saturation, respiratory rate (RR), and vital signs were monitored daily until pain control was achieved.

Results: 30 patients completed the study of which 29 are reported. The mean ET-CO2 at initial evaluation was 33.39 {mp} 5.0 and 34.79 {mp} 5.7 mmHg at pain control (P =0.14, 95% CI -0.5 to 3.3). None had an ET-CO2 ≥50 mmHg. All maintained O2 saturation ≥92%. RR dropped transiently below 10/minute in two subjects.

Conclusions: Parenteral opioid titration for relief of cancer pain was not associated with respiratory depression as demonstrated by significant changes in ET-CO2 or oxygen saturation in non-oxygen dependent cancer patients.

Key Words: cancer • carbon dioxide • opioids • oxygen • pain • respiratory


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Palliative Medicine, March 1, 2007; 21(2): 77 - 80.
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