Korean J Pain.  2014 Apr;27(2):139-144. 10.3344/kjp.2014.27.2.139.

Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management

• Heo BH
• Pyeon TH
• Lee HG
• Kim WM
• Choi JI
• Yoon MH

• KMID: 2074060
• DOI: http://doi.org/10.3344/kjp.2014.27.2.139

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.

Keyword

cancer pain; efficacy; epidural catheter; port; side effects

MeSH Terms

Analgesia
Analgesia, Epidural
Analgesics
Catheterization
Catheters
Drug Delivery Systems
Humans
Injections, Subcutaneous
Korea
Medical Records
Morphine*
Nausea
Pain Management*
Paresthesia
Retrospective Studies
Vomiting
Weights and Measures
Analgesics
Morphine

Figure

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  Fig. 1 Epidural port with connection site.

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  Fig. 2 Numeric rating scale at base-line and at the follow-up visits. The values are expressed as the means ± SD. Significant decreases in numeric rating scale were observed on postoperative days to baseline. *P < 0.05 compared to baseline using the Wilcoxon signed-ranks test.

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