The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Intrathecal Catheter and Subcutaneous Access Port Implantation in Pain Management for Terminal Cancer Patient - A case report -

말기암 환자의 통증치료를 위한 지주막하강내 카테터 거치와 피하 이식형 약제 주입기 삽입 - 증례보고 -

  • Seo, Kwi Chu (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Chung, Jin Yong (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Kim, Ho Young (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Rho, Woon Seok (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Kim, Bong Il (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu) ;
  • Song, Seok Young (Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu)
  • 서귀주 (대구가톨릭대학교 의과대학 마취통증의학교실) ;
  • 정진용 (대구가톨릭대학교 의과대학 마취통증의학교실) ;
  • 김호영 (대구가톨릭대학교 의과대학 마취통증의학교실) ;
  • 노운석 (대구가톨릭대학교 의과대학 마취통증의학교실) ;
  • 김봉일 (대구가톨릭대학교 의과대학 마취통증의학교실) ;
  • 송석영 (대구가톨릭대학교 의과대학 마취통증의학교실)
  • Received : 2007.09.20
  • Accepted : 2007.11.19
  • Published : 2007.12.10
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Abstract

It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.

Keywords

References

  1. Kramcs ES: The chronic intraspinal use of opioid and local anesthetic mixtures for the relief of intractable pain: when all else fails! Pain 1993; 55: 1-4 https://doi.org/10.1016/0304-3959(93)90182-O
  2. Krames ES: Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manage 1993; 8: 36-46 https://doi.org/10.1016/0885-3924(93)90118-F
  3. Nitescu P, Hultman E, Appelgren L, Linder LE, Curelaru I: Bacteriology, drug stability and exchange of percutaneous delivery systems and antibacterial filters in long-term intrathecal infusion of opioid drugs and bupivacaine in "refractory" pain. Clin J Pain 1992; 8: 324-37 https://doi.org/10.1097/00002508-199212000-00007
  4. Motitake K, Handa H, Umeda S, Nishioka T, Suwa H, Konishi T, et al: Implantable continuous epidural morphine infussion system for relief of chronic cancer pain. No Shinkei Geka 1986; 14: 761-8
  5. Sjoberg M, Nitescu P, Appclgrcn L, Curelaru I: Long-term intrathecal morphine and bupivacainc in patients with refractory cancer pa in. Results from a morphine: bupivacaine dose regimen of 0.5:4.75 mg/ml. Anesthesiology 1994; 80: 284-97 https://doi.org/10.1097/00000542-199402000-00008
  6. Smith TJ, Staats PS, Deer T, Steams LJ. Rauck RL, Boortz-Marx RL, et al: Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 2002; 20: 4040-9 https://doi.org/10.1200/JCO.2002.02.118
  7. Hassenbusch SJ: Cost modeling for alternate routes of administration of opioids for cancer pain. Oncology (Williston Park) 1999; 13(5 Suppl 2): 63-7
  8. Benedetti C, Brock C, Cleeland C, Coyle N, Dube JE, Ferrell B, et al: NCCN practice guidelines for cancer pain. Oncology (Williston Park) 2000; 14: 135-50
  9. Meuser T. Pietruck C, Radbruch L. Sture P, Lehmann KA, Grond S: Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 2001; 93: 247-57 https://doi.org/10.1016/S0304-3959(01)00324-4
  10. Burton AW. Rajagopal A, Shah HN, Mendoza T, Clecland C. Hassenbusch SJ 3rd, et al: Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med 2004; 5: 239-47 https://doi.org/10.1111/j.1526-4637.2004.04037.x
  11. Gcsrin Y, Vainio A, Pegurier AM: Long-term intrathecal infusion of morphine in the home care of patients with advanced cancer. Acta Anaesthesiol Scand 1997; 41: 12-7 https://doi.org/10.1111/j.1399-6576.1997.tb04607.x
  12. Crul BJ, Delhaas EM: Technical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg Ancsth 1991; 16: 209-13
  13. Sjoberg H, Karlsson PA, Nordberg C, Wallgren A, Nitescu P, Appclgren L, et al: Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 1992; 76: 173-86 https://doi.org/10.1097/00000542-199202000-00004
  14. Appelgren L, Nordberg C, Sjoberg M, Karlsson PA, Nitcscu P, Curelaru I: Spinal epidura l metastasis: implications for spinal analgesia to treat 'refractory" cancer pain. J Pain Symptom Manage 1997; 13: 25-42 https://doi.org/10.1016/S0885-3924(96)00203-5
  15. Akerman B, Arwestrom E. Post C: Local anesthetics potentiate spinal morphine antinociception. Anesth Analg 1988; 67: 943-8
  16. Van Dongen RT. Crul BJ, De Bock M: Long-term intrathecal infusion of morphine and morphine/bupivacaine mixtures in the treatment of cancer pain: a retrospective analysis of 51 cases. Pain 1993; 55: 119-23 https://doi.org/10.1016/0304-3959(93)90191-Q
  17. Sjoberg M, Appelgrcn L, Einarsson S, Hultman E, Linder LE, Nitescu P, et al: Long-term intrathecal morphine and bupivacaine in "refractory" cancer pain. I. Results from the first series of 52 patients. Acta Anaesthesiol Scand 1991; 35: 30-43 https://doi.org/10.1111/j.1399-6576.1991.tb03237.x
  18. Nitescu P, Appclgrcn L, Linder LE, Sjoberg M, Hultman E, Curclaru I: Epidural versus intrathecal morphine-bupivacame: assessment of consecutive treatments in advanced cancer pain. J Pain Symptom Manage 1990; 5: 18-26 https://doi.org/10.1016/S0885-3924(05)80005-3
  19. Abla AA, Rothfus WE, Maroon JC, Deeb ZL: Delayed spinal subarachnoid hematoma: a rare complication of CI-C2 cervical myelography. AJNR Am J Neuroradiol 1986; 7: 526-8
  20. Holmfred A, Vikerfors T, Berggren L, Gupta A: Intrathecal catheters with subcutaneous port systems in patients with severe cancer-related pain managed out of hospital: the risk of infection. J Pain Symptom Manage 2006; 31: 568-72 https://doi.org/10.1016/j.jpainsymman.2005.11.010
  21. Shields DC, Palma C, Khoo LT, Ferrante FM: Extramedullary intrathecal catheter granuloma adherent to the conus medullaris presenting as cauda equina syndrome. Anesthesiology 2005; 102: 1059-61 https://doi.org/10.1097/00000542-200505000-00026
  22. Coffey RJ, Burchiel K: Inflammatory mass lesions associated with intrathecal drug infusion catheters: report and observations on 41 patients. Neurosurgery 2002; 50: 78-86 https://doi.org/10.1097/00006123-200201000-00014

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