Subcutaneous morphine is superior to intrathecal morphine for pain control in a patient with hypernephroma.
This case report illustrates differences in analgesia quality and morphine consumption between an intrathecal infusion and the subcutaneous instillation of morphine in a cancer patient with hypernephroma. Superior analgesia was obtained with a 450 mg dose of subcutaneous morphine [i.e., visual analog scale (VAS) score 0/10] than with 10 mg intrathecal morphine/day administered at the thoracolumbar (twelfth dorsal vertebra) level (VAS score 2/10). If the instillation occurs at the lumbosacral level (between the last lumbar and the first sacral vertebra), a dosage of 70 mg morphine/day cannot induce the same pain relief as 450 mg subcutaneous morphine (VAS score 5/10 vs. 0/10). In some cancer patients, subcutaneous morphine offers superior pain control than intrathecal morphine.
Devulder
J E
JE
Department of Anaesthesia-Section Pain Clinic, University Hospital of Ghent, Belgium.
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000150:complications*; D006801:Humans; D007278:Injections, Spinal; D007279:Injections, Subcutaneous; D007680:Kidney Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement
D000701:Analgesics, Opioid; D009020:Morphine