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Treatment of severe cancer pain with epidural morphine
500 Poster
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THE TRIPLE UI'ILISATIONOF AN INDWELLING INL'KA'I'HECAL CATHETE Tuesday IN TREATING A CANCEK PATIENT. E. Plchard, Ph. Poulain*, ; Cascade 20 M. Spielmann*, J. Truffa-Bachi*, Departmentsof Anesthesiolo-~qy and Medicine of Institut Gustave Roussy, C'illeJuif,FRANCE.
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Aim of Investigation : Patients 111an advanced period of mctastatic cancer often need curative treatment associated with pain treatment. Our study shows one case whereby two treatments are realis& simultaneously in a non-aggressive manner. Methods : A 58-year oElwcman had a metastatic meningitis, a paintul iliz metastasis in correlation with breast cancer. A silastic lntrdthecal catheter connected to a silastic reservoir is inserted subcutaneously at the Ll L2 level. Through this reservoir, 0.8 - 1 ml of Morphine Chloride 1s injectid daily. In the same manner, each month we withdraw CSF fluid for analysis and inject 15 mq of Methotrexate. Results : Pain is always relieved with the same daily dose. Side effects such as nausea, gastric spasms are controlled with weak doses of neuroleptic. The metastatic meninqitis is stabilised over a six-months period without infection. Conclusions : The implanted intrathecal catheter reservoir dllowed fluid surveillance and treatment of the metastatic cancer as well as the pain treatment in a non-agqressive and confortable manner for the patient.
TREATMENT OF SEVERE CANCER PAIN WITH EPIDURAL MORPHINE. :;;s;;;ter S.Husebo:Dep.of.Anesthes.,5016 Haukeland Sykehus, (3pDKD.M.Sjaastad,tlniversit,v of Trondheim),Norway. Cascade 21 Aim of investigation:Opiates administered through epidura L catheter are shown to give efficient pain relief in acute and chronic pain. In thir study pain relief, side effects and practical problems are followed up over a period of 18 months in 46 patients with severe cancer pain. Methods: Morphine was administered through epidural catheter to 46 pat. whonatisfactory pain relief or negativeside effects after treatment with oral opiates. Results: Ages ranged from 4-76 years. Morphine doses from 2-120 mg were givmimes daily. Only 4 pat. had good pain relief before treatment. 2 weeks after treatment with morphine through epidural catheter 44 patients were painfree or had good pain relief. The pat. with constant pain needed less morphine (mean 14 mg daily) and had better pain relief than the pat. with intermittent pain (mean 28 mg). Duration of treatment was 2-356 days. 18 patients who mostly had intermittent pain needed higher doses at end of treatment, but still had good pain relief. 21 pat. remained at home up to continously 263 days. Catheter had to be changed in 26 patients, in 2 pat. due to suspected catheter infection. Culture of the catheter tip was neg.in both cases. Respiratory depression and neurological sequela were not observed. 2 of the pat., with oral cancer pain, one with the catheter inserted at thoracic level, the other at lumbal spinal level, had excellent Pain relief. We still recommend to insert the catheter at the spinal level of maximal pain. This gives the possibility to combine long-lasting-local anesthetics with opiates and gives better pain relief to pat. with most severe pain. Conclusions:Morphine treatment through epid.cath. is a safe method with poor side effects and remarkable benefits to pat.with severe cancer Pain.
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THE TRIPLE UI'ILISATIONOF AN INDWELLING INL'KA'I'HECAL CATHETE Tuesday IN TREATING A CANCEK PATIENT. E. Plchard, Ph. Poulain*, ; Cascade 20 M. Spielmann*, J. Truffa-Bachi*, Departmentsof Anesthesiolo-~qy and Medicine of Institut Gustave Roussy, C'illeJuif,FRANCE.
4
Aim of Investigation : Patients 111an advanced period of mctastatic cancer often need curative treatment associated with pain treatment. Our study shows one case whereby two treatments are realis& simultaneously in a non-aggressive manner. Methods : A 58-year oElwcman had a metastatic meningitis, a paintul iliz metastasis in correlation with breast cancer. A silastic lntrdthecal catheter connected to a silastic reservoir is inserted subcutaneously at the Ll L2 level. Through this reservoir, 0.8 - 1 ml of Morphine Chloride 1s injectid daily. In the same manner, each month we withdraw CSF fluid for analysis and inject 15 mq of Methotrexate. Results : Pain is always relieved with the same daily dose. Side effects such as nausea, gastric spasms are controlled with weak doses of neuroleptic. The metastatic meninqitis is stabilised over a six-months period without infection. Conclusions : The implanted intrathecal catheter reservoir dllowed fluid surveillance and treatment of the metastatic cancer as well as the pain treatment in a non-agqressive and confortable manner for the patient.
TREATMENT OF SEVERE CANCER PAIN WITH EPIDURAL MORPHINE. :;;s;;;ter S.Husebo:Dep.of.Anesthes.,5016 Haukeland Sykehus, (3pDKD.M.Sjaastad,tlniversit,v of Trondheim),Norway. Cascade 21 Aim of investigation:Opiates administered through epidura L catheter are shown to give efficient pain relief in acute and chronic pain. In thir study pain relief, side effects and practical problems are followed up over a period of 18 months in 46 patients with severe cancer pain. Methods: Morphine was administered through epidural catheter to 46 pat. whonatisfactory pain relief or negativeside effects after treatment with oral opiates. Results: Ages ranged from 4-76 years. Morphine doses from 2-120 mg were givmimes daily. Only 4 pat. had good pain relief before treatment. 2 weeks after treatment with morphine through epidural catheter 44 patients were painfree or had good pain relief. The pat. with constant pain needed less morphine (mean 14 mg daily) and had better pain relief than the pat. with intermittent pain (mean 28 mg). Duration of treatment was 2-356 days. 18 patients who mostly had intermittent pain needed higher doses at end of treatment, but still had good pain relief. 21 pat. remained at home up to continously 263 days. Catheter had to be changed in 26 patients, in 2 pat. due to suspected catheter infection. Culture of the catheter tip was neg.in both cases. Respiratory depression and neurological sequela were not observed. 2 of the pat., with oral cancer pain, one with the catheter inserted at thoracic level, the other at lumbal spinal level, had excellent Pain relief. We still recommend to insert the catheter at the spinal level of maximal pain. This gives the possibility to combine long-lasting-local anesthetics with opiates and gives better pain relief to pat. with most severe pain. Conclusions:Morphine treatment through epid.cath. is a safe method with poor side effects and remarkable benefits to pat.with severe cancer Pain.