OUTCOME AND COMPLICATIONS OF EPIDURAL ANALGESIA IN PATIENTS WITH CHRONIC CANCER PAIN

BACKGROUND. Some cancer patients require invasive techniques for contr ol of chronic cancer pain. Many patients have benefited front local ad ministration of opioids and anesthetics through an epidural catheter, However, epidural abscess and meningitis are side effects of epidural catheters that have serious morbidity and mortality. METHODS. In a ret rospective study, the charts of all patients who received an epidural catheter for the management of chronic cancer pain in a 3-year period (1993-1996) were reviewed. Patients with nervous system infections wer e identified and pertinent clinical, radiologic (magnetic resonance im aging), and bacteriologic data were analyzed. RESULTS, Ninety-one pati ents received 137 epidural catheters for a total of 4326 catheter days , All but four patients had died at the time of the final analysis. Th e median survival after placement of the first epidural catheter was 3 8 days (range, 1 day-> 1000 days). Seventy-two patients received a per cutaneous port whereas 19 patients were treated with an implanted subc utaneous port. Adequate pain relief was obtained in 76% of the 58 pati ents with nociceptive pain and in 73% of 33 patients with neuropathic pain. All neuropathic pain was associated with active tumor and could be classified as nociceptive nerve pain. Technical complications and s uperficial infections occurred in as many as 43% of patients. Deep inf ections occurred in 12 patients, 11 of whom had a spinal epidural absc ess. CONCLUSIONS. Deep infection is a frequent complication of epidura l analgesia and is associated with a high morbidity and mortality. Onl y cancer patients with a short life expectancy (less than or equal to 3 months) should be treated with epidural analgesia. Cancer 1998;83:20 15-22. (C) 1998 American Cancer Society.