title: A comparison of postoperative epidural analgesia between patients with chronic cancer taking high doses of oral opioids versus opioid-naive patients.
abstract: Our study evaluated 116 surgical patients with cancer who received postoperative epidural analgesia with bupivacaine (BUP) (0.1%) and morphine (MS) (0.01%) during 5 days after epidural-light general anesthesia. Patients in group I (n = 17) were taking opioids in doses larger than 50 mg of morphine daily for 3 mo or more, whereas patients in group II (n = 99) were opioid-naive. Postoperative epidural infusions were started at 10 mL.h-1 for group I and 5 mL.h-1 for group II. All patients were evaluated every 6 h for pain, withdrawal, and overdosing. Dynamic pain scores were kept below 4/10 by titrating infusions and/or giving intravenous (IV) MS 4 mg every hour as needed. Fifteen patients were taking opioids for 3-6 mo and the remainder for more than 6 mo. Mean oral MS preoperative usage for group I was 183 mg (90-360 mg range). All patients experienced adequate analgesia. Group I required more epidural (137 vs 44 mg) and IV (48 vs 10 mg) MS and had a longer requirement for analgesic therapy (9 vs 3 days) when compared with group II. Daily epidural and IV MS usage were always more for group I by two- to threefold. No patient experienced respiratory depression or opioid withdrawal during the hospitalization. Thus, epidural BUP-MS appears to provide adequate postoperative analgesia while preventing withdrawal in opioid-dependent patients, if three times the normal dosage and duration of therapy are employed.
authors.affiliation: Dept. of Anesthesiology, Roswell Park Cancer Institute, Buffalo, NY 14263.
authors.forename: O A
authors.initials: OA
authors.lastname: de Leon-Casasola
authors.forename: D P
authors.initials: DP
authors.lastname: Myers
authors.forename: S
authors.initials: S
authors.lastname: Donaparthi
authors.forename: D R
authors.initials: DR
authors.lastname: Bacon
authors.forename: J
authors.initials: J
authors.lastname: Peppriell
authors.forename: J
authors.initials: J
authors.lastname: Rempel
authors.forename: M J
authors.initials: MJ
authors.lastname: Lema
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine; D009294:Narcotics / Q000008:administration & dosage*; D009369:Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D010149:Postoperative Pain / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D009294:Narcotics; D009020:Morphine; D002045:Bupivacaine