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
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Background:Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods:Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the 1st, 3rd, 7th and 30th postoperative days were determined from medical records. Results:Intrathecal morphine administration for 46.0 ± 61.3 days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the 7th and 30th postoperative days compared to the 1st postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions:Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.
Abstract
Background:Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods:Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the 1st, 3rd, 7th and 30th postoperative days were determined from medical records. Results:Intrathecal morphine administration for 46.0 ± 61.3 days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the 7th and 30th postoperative days compared to the 1st postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions:Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.
참고문헌 (17)
- Holmfred A, "Intrathecal catheters with subcutaneous port systems in patients with severe cancer-related pain managed out of hospital: the risk of infection", J Pain Symptom Manage, 31, pp.568~572 (2006)
- Vissers KC, "23. Pain in patients with cancer", Pain Pract, 11, pp.453~475 (2011)
- Smith TJ, "Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival", J Clin Oncol, 20, pp.4040~4049 (2002)
- Deer TR, "Comprehensive consensus based 1. guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain", Pain Physician, 14, pp.E283~E312 (2011)
- 홍성호, "경추부 척수강내 카테터를 이용한 상체부의 암성통증 관리 —증례보고—", Korean Journal of Anesthesiology, 55(1), pp.135~138 (2008), 대한마취통증의학회
- 서귀주, "말기암 환자의 통증치료를 위한 지주막하강내 카테터 거치와 피하 이식형 약제 주입기 삽입-증례보고-", The Korean Journal of Pain, 20(2), pp.240~245 (2007), 대한통증학회
- Mercadante S, "Conversion ratios for opioid switching in the treatment of cancer pain: a systematic review", Palliat Med, 25, pp.504~515 (2011)
- Rauck RL, "Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain", J Pain, 4, pp.441~447 (2003)
- Becker R, "The significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions", Stereotact Funct Neurosurg, 75, pp.16~26 (2000)
- Angst MS, "Opioid-induced hyperalgesia: a qualitative systematic review", Anesthesiology, 104, pp.570~587 (2006)
- Krames ES, "Intrathecal infusional therapies for intractable pain: patient management guidelines", J Pain Symptom Manage, 8, pp.36~46 (1993)
- Belverud S, "Intrathecal pumps", Neurotherapeutics, 5, pp.114~122 (2008)
- Aldrete JA, "Intrathecal opioid infusions", Anesthesiology, 101, pp.256~ (2004)
- Anderson VC, "A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain", Neurosurgery, 44, pp.289~300 (1999)
- Bailey PL, "Dose-response pharmacology of intrathecal morphine in human volunteers", Anesthesiology, 79, pp.49~59 (1993)
- Winkelmüller M, "Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology", J Neurosurg, 85, pp.458~467 (1996)
- Kroin JS, "The distribution of medication along the spinal canal after chronic intrathecal administration", Neurosurgery, 33, pp.226~230 (1993)