Y. Gestin et al., LONG-TERM INTRATHECAL INFUSION OF MORPHINE IN THE HOME CARE OF PATIENTS WITH ADVANCED CANCER, Acta anaesthesiologica Scandinavica, 41(1), 1997, pp. 12-17
Background: Fear of infections and other complications has made many c
linicians avoid intrathecal application of morphine in chronic cancer
pain. However, recent comparative studies show that, in long-term trea
tment, intrathecal morphine administration may give a more satisfactor
y pain relief with lower doses of morphine and fewer side-effects than
epidural administration. In Montpellier Cancer Institute, first cance
r pain patients received long-term intrathecal morphine as early as in
1979, and since then more than 400 patients have been treated. Method
s: In 1991-1994, 50 patients having refractory cancer pain were treate
d with a continuous intrathecal infusion of morphine using an external
pump with patient-controlled boluses. In this retrospective study, th
e outcome of these 5602 days of morphine therapy will be analysed. The
treatment consisted of a lateral puncture technique, strictly aseptic
conditions during catheter insertion and changes of pump reservoirs,
and effective prevention of side-effects. Results: The average duratio
n of intrathecal infusion was 142 (7-584) days. The mean starting dose
, 2.5 (0.4-8.3) mg/day, increased to a mean final dose of 9.2 (1-94) m
g/day, the average dose being 5.4 (1-23) mg/day. During the treatment
period, no clinically detectable infections and no respiratory depress
ion occurred. Leakage of cerebrospinal fluid followed by post-spinal h
eadache occurred in only 6 patients who received a temporary external
catheter: the lateral lumbar puncture technique seemed to protect from
this complication in long-term treatment. The patients stayed at home
, coming to agreed control visits only at 4-6-week intervals, using a
telephone-telefax service for emergencies. Conclusions: Long-term intr
athecal morphine infusion seems to provide satisfactory analgesia, few
side-effects and a high degree of patient autonomy.