The effectiveness of subcutaneously implanted epidural ports for relief of severe pain in patients with advanced-stage gynecological cancer: a prospective study.
OBJECTIVE
We aimed to evaluate the effectiveness of subcutaneously implanted epidural ports (SIEP) in the management of patients with advanced-stage gynecologic cancer-related severe chronic pain who do not respond to intravenous tramadol infusion, transdermal fentanyl, and oral morphine administration or who cannot tolerate the unacceptable and unmanageable side effects of these drugs.


METHODS
In this prospectively designed study, SIEP to permit the administration of morphine were implanted for relief of severe chronic pain in 21 cases with stage IV gynecological cancer (ovarian [n=6], endometrium [n=3], cervix [n=10], vaginal [n=1], and vulvar [n=1]). In order to define the level of pain, visual analogue scale (VAS) and patient satisfaction score (PSS) were used before and on the 5th, 15th, and 30th days after epidural port application.


RESULTS
The mean overall survival period of the cases undergoing epidural port application was 80 days (range: 31-560). In terms of pain parameters, values at the end of the 5th, 15th and 30th days (VAS2, VAS3 and VAS4) were significantly lower than the value before morphine application via SIEP (VAS1) (p<0.01). PSSs at the 5th, 15th and 30th days were significantly higher than the PSS before port implantation (p<0.05). Pain management was started with 2 mg morphine with a maximum of 4 mg morphine administered into the epidural space per day. No clinically detected infectious condition or morphine-related side effects that required treatment occurred during the follow-up.


CONCLUSIONS
Morphine administration via SIEP provided excellent pain relief without creating side effects, increased patient quality of life, and contributed to the patient's ability to enjoy life.
Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey. drertas@gmail.com.
Ibrahim Egemen
IE
Ertaş
Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey.
Salim
S
Sehirali
Department of Anesthesiology and Reanimation, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey.
Serpil
S
Ozsezgin Ocek
Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey.
Muzaffer
M
Sancı
Department of Anesthesiology and Reanimation, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey.
Gulderen
G
Arbak
Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey.
Yusuf
Y
Yıldırım
D000279:Administration, Cutaneous; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004824:Epidural Space; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005833:Genital Neoplasms, Female / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy / Q000517:prevention & control*; D010166:Palliative Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D014421:Turkey; D062666:Vascular Access Devices
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl