Circadian distribution of extra doses of narcotic analgesics in patients with cancer pain: a preliminary report

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Abstract
Using the Edmonton Injector, and none had incidental pain or cognitive impairment. A total of 1322 extra doses of narcotics (each dose = 10% of the daily dose) were administered during 610 patient days (average of 2.17 ± 1.6 doses/patient/day). The mean daily number of extra doses during each interval was as follows: 02.00–06.00 h (0.24 ± 0.27), 06.00–10.00 h (0.26 ±0.31), 10.00–14.00 h (0.43 ± 0.44), 14.00–18.00 h (0.44 ± 0.41), 18.00–22.00 h (0.40 ± 0.36), and 22.00–02.00 h (0.40 ± 0.36) (02.00–06.00 h and 06.00–10.00 h vs. 10.00–02.00 h: P < 0.01). Forty-five of 61 patients (76%) received most of their extra doses of narcotics between 10.00 and 22.00 h. The data suggest that our patients require a larger number of extra doses during day time. Our design cannot establish the reason for this circadian variation. ∗Correspondence to: Dr. Eduardo Bruera, Director Palliative Care Program, Edmonton General Hospital, 11111 Jasper Avenue, Edmonton, Alberta T5K 0L4, Canada. Tel.: (403) 482-8531. (Received 19 October 1990; revised 5 December 1991; accepted 9 December 1991.) © Lippincott-Raven Publishers....