The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Cancer Pain Management by Continuous Epidural Morphine Infusion via Subcutaneous Tunneling

경막외 카테터 피하매몰법을 이용한 지속적 모르핀 투여에 의한 말기암 환자의 통증관리

  • Ryu, Sie Jeong (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Choi, Hyung Kyu (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Kim, Jun Young (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Kim, Doo Sik (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Jang, Tae Ho (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Kim, Se Hwan (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University) ;
  • Kim, Kyung Han (Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University)
  • 류시정 (고신대학교 의과대학 마취통증의학교실) ;
  • 최형규 (고신대학교 의과대학 마취통증의학교실) ;
  • 김준영 (고신대학교 의과대학 마취통증의학교실) ;
  • 김두식 (고신대학교 의과대학 마취통증의학교실) ;
  • 장태호 (고신대학교 의과대학 마취통증의학교실) ;
  • 김세환 (고신대학교 의과대학 마취통증의학교실) ;
  • 김경한 (고신대학교 의과대학 마취통증의학교실)
  • Received : 2005.03.03
  • Accepted : 2005.05.12
  • Published : 2005.06.30
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Abstract

Background: Most terminal cancer patients suffered from intractable pain. For the treatment of these patients, opioids, via various routes, are usually administered. Continuous epidural opioid, especially morphine, administration is a good method for the management of intractable cancer pain. Methods: We retrospectively analyzed 347 terminal cancer patients, who had been treated with continuous epidural morphine infusion, between 1999 and 2004. For the epidural infusion, an epidural catheter was inserted, tunneled subcutaneously and exited from the anterior chest or abdomen. Multiday $Infursor^{(R)}$ (Baxter, 0.5 ml/h) was used for the continuous infusion. Results: Of the 347 patients studied, there were 211 males and 136 females. The mean treatment time was 54.7 days, ranging from 5 to 481 days. The mean starting and termination doses of morphine were 32.4 (for 5 days) and 100.0 mg, respectively. The doubling time of the morphine dose was 26.3 days, corresponded to a 3.8 percent increase per day. Incidental catheter removal was the most common side effect, which occurred 130 times in 61 cases. Conclusions: The procedure of epidural catheterization, with subcutaneous tunneling, was simple and inexpensive. Despite the disadvantages, such as incidental catheter removal, it is a useful method for the control of terminal cancer pain.

Keywords

References

  1. Behar M, Magora F, Olshwang D, Davidson JT: Epidural morphine in treatmenr of pain. Lancet 1979; 1: 527-9.
  2. Jean JK, Chung JK, Chung SB: A treatment for intractable pain. Korean J Pain 1988; 1: 59-63.
  3. Yoon DK, Chung SY, Oh HK, Kim JY: Epidural administration of morphine for cancer pain via portal system. Korean J Pain 1996; 9:69-74.
  4. Hong KH: Totally implanted port system for terminal cancer pain;Problems and complications. Korean J Pain 1992; 5: 23-8.
  5. Fitzgibbon: Cancer Pain: Management. In: Bonica's Management of Pain. 3rd ed. Edited by LoeserJD: Philadelphia, Lippincott Williams & Wilkins. 2001, p 664.
  6. Onofrio BM, Yaksh TL, Arnold PG: Continuous low dose, intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc 1981; 56: 516-20.
  7. Erdiae and Yucel A: Long-term results of intrathecal morphine in 65 patients. The Pain Clinic 1994; 7: 27-33.
  8. Bonica J]: Continuous epidural block. Anesthesiology 1956; 17: 626.
  9. Polerti CE, Cohen AM, Todd DP, Ojemann RG, Sweet WH, Zervas NT: Cancer pain relived by long-term epidural morphine with permanent indwelling system for self administration. J Neurosurg 1981; 55: 581-4. https://doi.org/10.3171/jns.1981.55.4.0581
  10. Raj PP: Practical management of pain. 2nd ed. St Louise, Mosby Year Book. 1992, pp 486-9.
  11. Lee SK, Park JH, Hong JG, Kim BK: Management of cancer pain using portable infusor. Korean J Anesthesiol 1995; 29: 428-32. https://doi.org/10.4097/kjae.1995.29.3.428
  12. Samuelsson H, Malmberg F, Eriksson M, Hedner T: Outcome of epidural morphine treatment on cancer pain: nine years of clinical experiences. J Pain Symprom Manage 1995; 10: 105-12. https://doi.org/10.1016/0885-3924(94)00071-R
  13. Phillips JM, Stedeford JC, Hartsilver E, Roberts C: Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2002; 89:778-82. https://doi.org/10.1093/bja/aef260
  14. de Jong PC, Kansen P]: A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain. Anesth Analg 1994; 78: 94-100.
  15. Ohlsson L, Rydberg T, Eden T, Persson Y, Thulin L: Cancer pain relief by continuous administration of epidural morphine in a hospital setting and at home. Pain 1992; 48: 349-53. https://doi.org/10.1016/0304-3959(92)90083-N
  16. Du Pen SL, Williams AR: The dilemma of conversion from systemic ro epidural morphine: a proposed conversion tool for treatment of cancer pain. Pain 1994; 56: 113-8. https://doi.org/10.1016/0304-3959(94)90156-2