The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Epidural Analgesia Using High Dose Morphine in a Terminal Lung Cancer Patient -A case report-

고용량 모르핀의 지속적 경막외주입에 의한 암성 통증 조절 -증례보고-

  • Lee, Ji Yeon (Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Shinn, Helen Ki (Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Kim, Tae Jung (Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Cho, Young Deog (Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Song, Ha Na (Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Yang, Chun Woo (Konyang University College of Medicine)
  • 이지연 (인하대학교 의과대학 마취통증의학교실) ;
  • 신혜란 (인하대학교 의과대학 마취통증의학교실) ;
  • 김태정 (인하대학교 의과대학 마취통증의학교실) ;
  • 차영덕 (인하대학교 의과대학 마취통증의학교실) ;
  • 송하나 (인하대학교 의과대학 마취통증의학교실) ;
  • 양춘우 (건양대학교 의과대학 마취통증의학교실)
  • Received : 2005.09.30
  • Accepted : 2005.12.23
  • Published : 2006.06.30
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Abstract

Pain control is very important in managing terminal cancer patients and there are several modalities to alleviate their pain. A high dosage of epidural morphine is effective to control terminal cancer pain. Furthermore, to decrease the amount of morphine, adding an alternative adjuvant like ketamine to the morphine regimen is considered helpful for controlling the pain of a terminal cancer patient. A 45 year old male patient with terminal lung cancer had neck pain that was caused by multiple bone metastases. Continuous epidural block was started with 2 mg/day of morphine and the dosage was gradually increased to 90 mg/day in 86 days. 30 mg/day of ketamine was then added to it. Overall, the morphine and ketamine dosages were increased to 564 mg/day and 140 mg/day, respectively, in 11 months until the patient expired. In this case, the high dosage of epidural morphine, 580 mg/day, was administered to control cancer pain without any severe adverse effects.

Keywords

References

  1. Cherny NI, Portenoy RK: Cancer pain: principles of assessment and syndromes. In: Texbook of Pain. 4th ed. Edited by Patrick DW, Ronald M: London, Churchill Livingstone. 1999, p 1017
  2. Kwon HW, Kim SH, Lim YS, Kang PS: Postoperative analgesic effect of combined low dose intrathecal morphine and continuous epidural opioid local anesthetic mixture aftet lumbar laminectomy. Korean J Pain Soc 2004; 17: 217-21 https://doi.org/10.3344/jkps.2004.17.2.217
  3. Fischer RL, Lubenow TR, Liceaga A, McCarthy RJ, Ivankovich AD: Comparison of continuous epidural infusion of fentanyl-bupivacaine and morphine-bupivacaine in management of postoperative pain. Anesth Analg 1988; 67: 559-63
  4. Donnelly S, Davis MP, Walsh D, Naughton M: Morphine in cancer pain management : a practical guide. Support Care Cancer 2002; 10: 13-35 https://doi.org/10.1007/s005200100274
  5. Yoon DM, Chung SY, Oh HK, Kim JY: Epidural administration of morphine for cancer pain via portal system. Korean J Pain Soc 1996; 9: 69-74
  6. Samuelsson H, Malmberg F, Eriksson M, Hedner T: Outcomes of epidural morphine treatment in cancel pain: nine years of clinical experience. J Pain Symptom Manage 1995; 10: 105-12 https://doi.org/10.1016/0885-3924(94)00071-R
  7. Plummer JL, Cherry DA, Cousins MJ, Gourlay GK, Onley MM, Evans KHA: Long-term spinal administration of morphine in cancer pain and non-cancer pain: a retrospective study. Pain 1991; 44: 215-20 https://doi.org/10.1016/0304-3959(91)90088-F
  8. Manfredi PL, Chandler SW, Patt R, Payne R: High-dose epidural infusion of opioids for cancer pain: cost issues. J Pain Symptom Manage 1997; 13: 118-21 https://doi.org/10.1016/S0885-3924(96)00266-7
  9. Ryu SJ, Han SM, Kim DS, Park SH, Kim KH, Jang TH, et al: Terminal cancer pain management by tunnelled epidural catheter. Korean J Pain Soc 1999; 12: 95-100
  10. Ilkjaer S, Dirks J, Brennum J, Wernberg M, Dahl JB: Effect of systemic N-methyl-D-aspartate receptor antagonist (Dextromethorphan) on primary and secondary hyperalgesia in humans. Br J Anesth 1997; 79: 600-5 https://doi.org/10.1093/bja/79.5.600
  11. Manning BH, Mao J, Frenk H, Price DD, Mayer DJ: Continuous co-administraion of dextromethorphan or MK-801 with morphine: attenuation of morphine dependence and naloxone-reversible attenuation of morphine tolerance. Pain 1996; 67: 79-88 https://doi.org/10.1016/0304-3959(96)81972-5
  12. Eisenach JC, DuPen S, Dubois M, Miguel R, Allin D: Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group. Pain 1995; 61: 391-9 https://doi.org/10.1016/0304-3959(94)00209-W
  13. Lauretti GR, Gomes JM, Reis MP, Pereira NL: Low doses of epidural ketamine ot neostigmine, but not midazolam, improve morphine analgesia in epidural tetminal cancer pain rherapy. J Clin Anesth 1999; 11: 663-8 https://doi.org/10.1016/S0952-8180(99)00122-1
  14. Goodchild CS, Noble J: The effects of intrathecal midazolam on sympathetic nervous system reflexs in man?a pilot study. Br J Clin Pharmacol 1987; 23: 279-85 https://doi.org/10.1111/j.1365-2125.1987.tb03046.x
  15. Kawana Y, Sato H, Shimada H, Fujita N, Ueda Y, Hayashi A, et al: Epidural ketamine for postoperative pain relief after gynecologic operations: a double blind study and comparison with epidural morphine. Anesth Analg 1987; 66: 735-8
  16. Naguib M, Adu-Gyamfi Y, Absood GM, Farag H, Gyashi HK: Epidural ketamine for postoperative analgesia. Can Anaesth Soc J 1986; 33: 16-21 https://doi.org/10.1007/BF03010903
  17. Ogawa S, Kanamaru T, Noda K: Intravenous microdrip infusion of ketamine in subanesthetic doses for intractable terminal cancer pain. Pain Clin 1994; 7: 125-9
  18. Vranken JH, Troost D, Wegener JT, Kruis MR, Van der Vegt MH: Neuropathological findings after continuous intrathecal administration of S( + )-ketamine fot the management of neutopathic cancer pain. Pain 2005; 117: 231-5 https://doi.org/10.1016/j.pain.2005.06.014
  19. Lauretti GR, Gomes JM, Reis MP, Peteira NL: Low doses of epidural ketamine or neostigmine, but not midazolam, improve morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth 1999; 11: 663-8 https://doi.org/10.1016/S0952-8180(99)00122-1