学会誌 VOL.19 No.1 March 2026

原著論文

終末期患者の退院前カンファレンスにおける病院薬剤師の現状
平井俊明・土屋　貴・宮﨑百合・萬谷摩美子・山中幸典・江口真理子・原田奈津子・仁木一順・近藤匡慶・内田まやこ・髙瀬久光

［要旨］退院前カンファレンス（以下，Pre-discharge Conference：P.D.C.）は退院後の患者に切れ目のない支援を実現し，QOL の維持・向上を図るために重要な会議であるが，病院薬剤師の参画状況についての実態は明らかになっていない．そこで今回，日本緩和医療薬学会会員の病院薬剤師を対象に終末期患者の P.D.C. に関する現状調査を行った．対象となる 2,576 名のうち 282 名から回答を得た．「参加したことがある」，「在宅チームに薬歴や注意点を伝えることができて良かった」との回答者はそれぞれ 197 名（70 %），169 名（79 %）であった．他方，「保険薬局薬剤師が参加していなかったため連携を十分に行えなかった」，「保険薬局薬剤師が参加することは有用である」との回答者はそれぞれ 106 名（50 %），158 名（74 %）であった．病院薬剤師にとって保険薬局薬剤師が終末期患者の P.D.C. に参加することは，薬薬連携の一環として継続的な薬学的管理を実施するために有用であると考えていることがわかった．

キーワード：終末期，退院前カンファレンス，薬薬連携，病院薬剤師

腹痛および腹部膨満感を呈する終末期がん患者に対するリドカイン持続投与の有用性
川村泰一・石川ゆりか・川上恭平・金島正幸・福富　晃・大野茂樹・安達　勇・佐藤哲観

［要旨］がん終末期の腹痛および腹部膨満感に対するリドカイン注射薬（静注用キシロカイン 2%Ⓡ　以下 Lid）の持続投与症例を後方視的に調査し，有用性と課題を検討した．対象は腹痛および腹部膨満感の緩和を目的に Lid持続静脈内投与または持続皮下投与（Lid 持続注）を実施した 170 例．Lid 導入後 48 時間以内に腹部症状の軽減を認めた場合を効果ありとし，関連する臨床因子を検討した．Lid の有効率は 53/170（31.2%）で，Lid 投与量が500 mg/日以上群は 500 mg/日未満群に対し（p ＝ 0.009），PS3 以下群は PS4 群に対し（p ＝ 0.026），それぞれ高い有効性を認めた．また Lid 導入から 48 時間以内の意識障害あるいは死亡の頻度は，PS4 群が PS3 以下群と比べて高かった（p ＝ 0.018）．腹痛および腹部膨満感を呈する終末期がん患者に対し Lid は有効な可能性があるが，中枢神経系の有害事象に留意する必要があると考えられた．

キーワード：がん，終末期，腹痛，腹部膨満感，リドカイン

A Novel Method for Determining Serum Levels of Tramadol and Its Active Metabolite Using High-Performance Liquid Chromatography Coupled with Electrochemical Detection
Masaki KIDA, Takahiko AOYAMA, Kazuaki KATAKAWA, and Hideya KOKUBUN

Abstract: 　Tramadol is primarily metabolized in the liver, where it is converted to the active metabolite
O-desmethyltramadol by CYP2D6. Because tramadol inhibits the reuptake of noradrenaline and serotonin, and O-desmethyltramadol has μ-opioid receptor agonist activity, the analgesic effect is surmised to vary depending on the metabolic activity of the liver. Therefore, understanding the pharmacokinetics of tramadol in detail is important. In this study, a simple and accurate method for measuring serum concentrations of tramadol and O-desmethyltramadol was developed using HPLC coupled with electrochemical detection (HPLC/ECD). An XTerra Ⓡ RP18 column was used, the electrochemical detector voltage was set at 1,300 mV, and 10 mM Na2HPO4/CH3CN (20:17) was selected as the mobile phase. As a result, the calibration curves were linear in the 12.5-250 ng/mL range. The intra- and inter-day coefﬁcients of variation were respectively less than 5.7%and 10.0% for tramadol and less than 6.0% and 4.3% for O-desmethyltramadol. Moreover, this method was used to measure the serum levels of these two compounds over time in a patient with cancer-associated pain who was treated with tramadol. In conclusion, this HPLC/ECD method is useful for measuring serum levels of tramadol and O-desmethyltramadol in patients with cancer.

Key words： Tramadol, O-desmethyltramadol, HPLC, pain

Investigation of Risk Factors for Discontinuation of Pregabalin in Cancer-related Neuropathic Pain
Shinsuke TAJIMA, Mana YAMAGUCHI, Chiemi SHOUHO, Chika TOGA, Mieko CHINZEI, Tadashi YOSHIDA, Ryoko SAKAI, and Manabu AKAZAWA

Abstract: 　Pregabalin is widely used for managing cancer-related neuropathic pain (CNP), but treatment may have to be discontinued due to adverse events, such as somnolence and dizziness. This retrospective study investigated factors associated with pregabalin discontinuation in patients with CNP, focusing on whether exceeding the initial dose recommended by renal function, as well as concomitant use of opioids or adjuvant analgesics, constituted risk factors. We assessed prescription patterns and estimated adjusted odds ratios (ORs, 95% conﬁdence intervals ［CIs］) for treatment discontinuation using multivariate logistic regression. Of the 254 patients analyzed, 38 (15.0%) discontinued treatment, with 21 (8.3%) discontinuing due to adverse events. The ORs ［95% CI］ for discontinuation were 0.99 ［0.96-1.02］ for age, 2.00 ［0.98-4.20］ for female sex, 1.08 ［0.05-7.09］ for exceeding the initial pregabalin dose recommended by renal function, 0.68 ［0.33-1.44］ for concomitant opioid use, and 0.42 ［0.02-2.39］ for concomitant use of adjuvant analgesics. None of the investigated factors were statistically confirmed as significant risk factors for discontinuation. At our institution, pregabalin is initiated at a low dose to reduce the risk of adverse events. Consequently, few patients exceeded the recommended dose based on renal function, which may have contributed to the low proportion of discontinuation. However, the single-center design and limited number of discontinuation cases restrict the generalizability of these ﬁndings, underscoring the need for further research in larger, multi-center populations.

Key words： adjuvant analgesics, adverse events, cancer-related neuropathic pain, pregabalin, risk factors for discontinuation

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