title: The evidence of neuraxial administration of analgesics for cancer-related pain: a systematic review.
abstract: BACKGROUND
  The present systematic review analysed the existing evidence of analgesic efficacy and side effects of opioids without and with adjuvant analgesics delivered by neuraxial route (epidural and subarachnoid) in adult patients with cancer.
  
  
  METHODS
  Search strategy was elaborated with words related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation.
  
  
  RESULTS
  The number of abstracts retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant analgesic compared with neuraxial administration of opioid alone (n = 4); single neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neuraxial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences in favour of the tested interventions.
  
  
  CONCLUSIONS
  Heterogeneous characteristics and several methodological limitations of the studies resulted in evidence of low quality and a weak recommendation for neuraxial administration of opioids with or without adjuvant analgesics in adult patients with cancer.
authors: Section of Palliative Medicine, Department of Oncology, Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors: G P
authors: GP
authors: Kurita
authors: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.|Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors: K S
authors: KS
authors: Benthien
authors: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.|Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors: M
authors: M
authors: Nordly
authors: Anesthesia and Intensive Care Unit, Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.|Department of Anesthesia, Intensive Care & Emergencies, University of Palermo, Palermo, Italy.
authors: S
authors: S
authors: Mercadante
authors: Department of Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors: P
authors: P
authors: Klepstad
authors: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark.|Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors: P
authors: P
authors: Sjøgren
mesh_terms: D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid