title: [Analgesia with an implanted device for repetitive intrathecal injections of morphine].
abstract: The use of intraspinal narcotics has been widely accepted as pain relief treatment for intractable cancer pain. Intraspinal low doses of morphine induce a potent selective long lasting analgesia. To avoid repetitive lumbar puncture, a drug delivery device was surgically implanted in 41 patients. The surgical procedure is described. The mean amount of morphine needed was 1.48 +/- 0.25 mg per day at time of surgery, rising to 6.86 +/- 1.47 mg per day after a mean survival time of 65 days. Tolerance became a major problem in 18 patients, which nearly all were selected at a late disease stage and previously received narcotics for pain relief. However, no clear-cut prognostic factor had a predictive value for the appearance of tolerance. In some cases, it could be successfully treated by intraspinal injection of local anaesthetics or clonidine. CSF leakage was noted in 11 patients; this was a challenge for us, as no other authors reported such a high rate for this complication. Aseptic meningitis was noted three times. In all cases but one, the symptoms resolved with appropriate treatment.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002908:Chronic Disease; D003000:Clonidine / Q000008:administration & dosage; D004361:Drug Tolerance; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D008239:Lysine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009369:Neoplasms / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy*; D011957:Receptors, Opioid / Q000032:analysis
chemical_list: D011957:Receptors, Opioid; D009020:Morphine; D008239:Lysine; D003000:Clonidine; D001241:Aspirin; C010395:acetylsalicylic acid lysinate
vernacular_title: Analgésie par site implantable pour injections intrathécales itératives de morphine.