Korean J Pain.  2013 Jan;26(1):32-38. 10.3344/kjp.2013.26.1.32.

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

• Kim JH
• Jung JY
• Cho MS

• KMID: 1779021
• DOI: http://doi.org/10.3344/kjp.2013.26.1.32

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.

Keyword

cancer pain; complications; efficacy; intrathecal morphine; side effects

MeSH Terms

Analgesia
Analgesics, Opioid
Catheters
Humans
Injections, Subcutaneous
Morphine
Pain Management
Pain, Intractable
Retrospective Studies
Stress, Psychological
Urinary Retention
Weights and Measures
Analgesics, Opioid
Morphine

Figure

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  Fig. 1 Intrathecal catheter placement and implantation of a subcutaneous injection port. (A) A disposable intrathecal catheterization set and subcutaneous injection port. (B) Subarachnoid radiocontrast spread after the injection via intrathecal catheter. (C) A tunneled intrathecal catheter connected to the implantable subcutaneous injection port. (D) A patient-ontrolled analgesia device for continuous morphine infusion.

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  Fig. 2 Numerical pain rating scales at baseline and at the follow-up visits. The values are expressed as the means ± SD. Significant reductions in pain intensity on all the postoperative days compared to baseline were observed. *P < 0.001 compared to baseline using a paired t-test. POD: postoperative day.

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  Fig. 3 Percent change from baseline in systemic opioid consumption. The values are expressed as the means ± SD. No significant changes in systemic opioid consumption were observed during the postoperative period. POD: postoperative day.

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  Fig. 4 Percent change from baseline in intrathecal opioid consumption. The values are expressed as the means ± SD. Significant increases in intrathecal opioid consumption were observed on postoperative days 7 and 30 compared to baseline. *P < 0.05 compared to baseline using the Wilcoxon signed-ranks test. †P < 0.01 compared to baseline using the Wilcoxon signed-ranks test. POD: postoperative day.

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