title: Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management.
abstract: BACKGROUND
  To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia.
  
  
  METHODS
  We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records.
  
  
  RESULTS
  The average score for the numerical pain rating scales for the 29 patients decreased from 7 ± 1.0 at baseline to 3.6 ± 1.4 on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia.
  
  
  CONCLUSIONS
  Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Bong Ha
authors.initials: BH
authors.lastname: Heo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Pyeon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyung Gon
authors.initials: HG
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Woong Mo
authors.initials: WM
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jeong Il
authors.initials: JI
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Myung Ha
authors.initials: MH
authors.lastname: Yoon
keywords: cancer pain; efficacy; epidural catheter; port; side effects
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