Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management
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Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from 7 ± 1.0 at baseline to 3.6 ± 1.4 on postoperative day 1 (P ＜ 0.001). A similar decrease in pain intensity was maintained for 30 days (P ＜ 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.
Abstract
Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from 7 ± 1.0 at baseline to 3.6 ± 1.4 on postoperative day 1 (P ＜ 0.001). A similar decrease in pain intensity was maintained for 30 days (P ＜ 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.
참고문헌 (24)
- Nordberg G, "Epidural versus intrathecal route of opioid administration", Int Anesthesiol Clin, 24, pp.93~111 (1986)
- Morgan M, "The rational use of intrathecal and extradural opioids", Br J Anaesth, 63, pp.165~188 (1989)
- Nitescu P, "Epidural versus intrathecal morphine-bupivacaine : assessment of consecutive treatments in advanced cancer pain", J Pain Symptom Manage, 5, pp.18~26 (1990)
- Crul BJ, "Technical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients : a review of 140cases", Reg Anesth, 16, pp.209~213 (1991)
- 김종해, "Continuous Intrathecal Morphine Administration for Cancer Pain Management Using an Intrathecal Catheter Connected to a Subcutaneous Injection Port: A Retrospective Analysis of 22 Terminal Cancer Patients in Korean Population", The Korean Journal of Pain, 26(1), pp.32~38 (2013), 대한통증학회
- Aldrete JA, "Intrathecal opioid infusions", Anesthesiology, 101, pp.256~ (2004)
- Krames ES, "Intraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines", J Pain Symptom Manage, 11, pp.333~352 (1996)
- Nitescu P, "Complications of intrathecal opioids and bupivacaine in the treatment of "refractory" cancer pain", Clin J Pain, 11, pp.45~62 (1995)
- McClellan KJ, "Levobupivacaine", Drugs, 56, pp.355~362 (1998)
- Ross VH, "Neostigmine decreases bupivacaine use by patientcontrolled epidural analgesia during labor : a randomized controlled study", Anesth Analg, 109, pp.524~531 (2009)
- Du Pen SL, "Infection during chronic epidural catheterization : diagnosis and treatment", Anesthesiology, 73, pp.905~909 (1990)
- Smitt PS, "Outcome and complications of epidural analgesia in patients with chronic cancer pain", Cancer, 83, pp.2015~2022 (1998)
- Maki DG, "Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters", Lancet, 338, pp.339~343 (1991)
- De Cicco M, "Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization", Anesthesiology, 82, pp.765~771 (1995)
- Waghorn DJ, "Intravascular device-associated systemic infections : a 2 year analysis of cases in a district general hospital", J Hosp Infect, 28, pp.91~101 (1994)
- de Jong PC, "A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain", Anesth Analg, 78, pp.94~100 (1994)
- Carde P, "Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration : a randomized trial in 100 patients with solid tumors", Eur J Cancer Clin Oncol, 25, pp.939~944 (1989)
- Orser B, "Obstetrical epidural anaesthesia in a Canadian outpost hospital", Can J Anaesth, 35, pp.503~506 (1988)
- Prince G, "Obstetric epidural test doses. A reappraisal", Anaesthesia, 41, pp.1240~1250 (1986)
- Guay J, "The epidural test dose : a review", Anesth Analg, 102, pp.921~929 (2006)
- de Leon-Casasola OA, "Interventional procedures for cancer pain management: when are they indicated?", Cancer Invest, 22, pp.630~642 (2004)
- Bedder MD, "Cost analysis of two implantable narcotic delivery systems", J Pain Symptom Manage, 6, pp.368~373 (1991)
- Harney D, "Traumatic syrinx after implantation of an intrathecal catheter", Reg Anesth Pain Med, 29, pp.606~609 (2004)
- Schimpf J, "Transverse myelopathy as a complication following long-term intrathecal application of morphine in chronic back pain", Anasthesiol Intensivmed Notfallmed Schmerzther, 34, pp.506~509 (1999)