Epidural opiates and local anesthetics for the management of cancer pain.
The role of epidural morphine in chronic cancer pain treatment is unresolved. In a population of 1205 cancer patients, the aggressive use of systemic opiates limited the trial of epidural analgesia to 16 cases. Successful analgesia was achieved with epidural morphine alone in 6 of these 16 cases following systemic opiate failure. The addition of bupivacaine produced analgesia in all of the 10 remaining cases and was successful chronically in 6 cases. Complications occurred in 11 of the 16 cases of epidural analgesia and included dislodged or broken catheters, pain on injection, hyperesthesia from epidural morphine and bleeding or infection related to the epidural catheter. Epidural morphine is indicated only in selected cancer pain patients and, although bupivacaine extends the efficacy of epidural analgesia, these methods are accompanied by problems and limitations.
Hogan
Quinn
Q
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Radiation Therapy, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A.
Haddox
David J
DJ
Abram
Stephen
S
Weissman
David
D
Taylor
Mary Lou
ML
Janjan
Nora
N
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D002045:Bupivacaine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
D009020:Morphine; D002045:Bupivacaine