SPINAL ANALGESIA IN TERMINAL CARE - RISK VERSUS BENEFIT

Cancer pain treatment is well established. The World Health Organizati on provides clinicians an ''analgesic ladder'' scheme to optimize canc er pain treatment. At the beginning of the pain treatment, oral analge sic administration is preferred. The analgesic dose must be individual ized. Many published papers describe the spinal administration of opio ids in combination with various other drugs such as bupivacaine in sel ected patients with cancer pain. Although complications have been repo rted to be few, some recent reports debate this idea. We first describ e a population of 92 cancer patients, 13 of whom received intrathecal morphine. We then present our experience with a separate group of 33 c ancer patients who were also managed using intrathecal morphine. Based on this experience, the generally accepted indications for the techni que appeared to be justified. Concern about spinal infection is well c onsidered, however. Three out of those patients developed meningitis, a complication rate that is far too high.