Use of Intraventricular and Intrathecal Morphine in Intractable Pain Associated with Cancer

Neurosurgery ◽  
1984 ◽  
Vol 15 (6) ◽  
pp. 801-803 ◽  
Author(s):  
Giancarlo Nurchi
Keyword(s):  
Side Effects ◽  
Intrathecal Morphine ◽  
Ommaya Reservoir ◽  
Intractable Pain ◽  
Percutaneous Injection

Abstract The use of the intraventricular or subarachnoid administration of morphine in the treatment of intractable pain secondary to cancer is described. The drug, in doses ranging from 0.33 to 4.00 mg, was administered by the percutaneous injection of an Ommaya reservoir or by a spinal tap. The duration of analgesia ranged from 36 to 150 hours. The indications for and side effects of this type of therapy are considered.

Management of patients with pain and severe side effects while on intrathecal morphine therapy: A case study

2017 ◽  
Vol 17 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Kehua Zhou ◽  
Sen Sheng ◽  
Gary G. Wang
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Management Approach ◽  
Intractable Pain ◽  
Pump Therapy ◽  
Pump Implantation ◽  
Morphine Therapy

AbstractBackground and aimsThe use of intrathecal morphine therapy has been increasing. Intrathecal morphine therapy is deemed the last resort for patients with intractable chronic non-cancer pain (CNCP) who failed other treatments including surgery and pharmaceutical interventions. However, effective treatments for patients with CNCP who “failed” this last resort because of severe side effects and lack of optimal pain control remain unclear.Methods and resultsHere we report two successfully managed patients (Ms. S and Mr. T) who had intractable pain and significant complications years after the start of intrathecal morphine therapy. The two patients had intrathecal morphine pump implantation due to chronic consistent pain and multiple failed surgical operations in the spine. Years after morphine pump implantation, both patients had significant chronic pain and compromised function for activities of daily living. Additionally, Ms. S also had four episodes of small bowel obstruction while Mr. T was diagnosed with end stage severe “dementia”. The successful management of these two patients included the simultaneous multidisciplinary approach for pain management, opioids tapering and discontinuation.ConclusionThe case study indicates that for patients who fail to respond to intrathecal morphine pump therapy due to side effects and lack of optimal pain control, the simultaneous multidisciplinary pain management approach and opioids tapering seem appropriate.

Intrathecal and intraventricular morphine for pain in cancer patients: initial study

1982 ◽  
Vol 56 (2) ◽  
pp. 241-245 ◽  
Author(s):  
Milam E. Leavens ◽  
C. Stratton Hill ◽  
David A. Cech ◽  
Jane B. Weyland ◽  
Jaye S. Weston
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Cancer Patients ◽  
Intrathecal Morphine ◽  
Initial Study ◽  
Intractable Pain ◽  
Content Type ◽  
Fine Print

✓ Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.

scholarly journals Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tao-ran Yang ◽  
Xue-mei He ◽  
Xue-han Li ◽  
Ru-rong Wang
Keyword(s):  
Sensitivity Analysis ◽  
Side Effects ◽  
Pain Score ◽  
Caesarean Delivery ◽  
Intrathecal Morphine ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Analgesic Effects ◽  
Registration Number

Abstract Background The number of caesarean deliveries has been increasing. Although intrathecal morphine (ITM) can relieve pain and is widely applied in caesarean deliveries, it is associated with many side effects. Transversus abdominis plane block (TAPB), a new analgesic technology, has also began playing a certain role after caesarean delivery, with fewer adverse effects. This study mainly compares the analgesic and adverse effects of ITM and TAPB in caesarean delivery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science, for randomised controlled trials (RCTs) published before 9 October, 2020 to compare the effects of ITM and TAPB. Primary outcome of the study was the pain score at rest 24 h after caesarean delivery, whereas the secondary outcomes were the pain score at movement 24 h after operation, postoperative nausea and vomiting (PONV), itching, and morphine consumption. For the outcome assessment, we conducted a sensitivity analysis. Result Six RCTs involving 563 patients and meeting the study inclusion criteria were included in this study. Results indicated no significant difference in the pain score between ITM and TAPB at 24 h of rest or movement. The sensitivity analysis results indicated that the resting pain score (95% CI = − 1.27 to − 0.28; P = 0.002) and 24-h moving pain score (95% CI = − 1.8 to − 0.07; P = 0.03) of the ITM group were lower than those of the TAPB group. The consumption of morphine in the ITM group was lower than in the TAPB group (95% CI = 1.92 to 4.87; P < 0.00001); however, in terms of adverse reactions, the incidence of pruritus (95% CI = 1.17 to 8.26; P = 0.02) and PONV (95% CI = 1.92 to 4.87, P < 0.00001) in the ITM group was higher than in the TAPB group. Conclusion Parturients in the ITM and TAPB groups exhibited similar analgesic effects. However, in the sensitivity analysis performed by eliminating the studies causing heterogeneity, the ITM group was found to have superior analgesic effects compared with the TAPB group, with less morphine consumption. Differently, the TAPB group displayed less side effects such as PONV. Therefore, TAPB is still a valuable analgesia option for patients who cannot use ITM for analgesia after caesarean delivery or those having a high risk of PONV. Trial registration Registration number: Registered on Prospero with the registration number of CRD42020210135.

scholarly journals A prospective randomised double blind study of the comparison of two opioids- fentanyl and buprenorphine – as adjuvant to spinal bupivacaine in caesarean sections

2017 ◽  
Vol 4 (1) ◽  
pp. 45
Author(s):  
Kamal Sonya ◽  
Davies C. V.
Keyword(s):  
Side Effects ◽  
Intrathecal Morphine ◽  
Maximum Level ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Blind Study ◽  
Maximum Height ◽  
Double Blind Study ◽  
Double Blind ◽  
Fentanyl Group

<p class="abstract"><strong>Background:</strong> Opioids are first introduced as additives to spinal anaesthesia in 1979, with intrathecal morphine as forerunner. Neuraxial opioids when added to local anaesthetics prolong the duration of sensory block, improve quality of block and no unwanted sympathetic blockade leading to hypotension. This prospective randomized double blind study was undertaken to evaluate the duration of analgesia, sensory and motor blocking properties and side effects of two opioids – Fentanyl and Buprenorphine, when used as adjuvant to spinal Bupivacaine in caesarean section.</p><p class="abstract"><strong>Methods:</strong> Sixty patients between the age group 18-35 years belonging to ASA I and II posted for elective LSCS were randomly divided into two groups. Each group consisting of 30 patients , received either 1.8 ml 0.5% Bupivacaine with 25 mcg Fentanyl (group F) or 1.8 ml 0.5% Bupivacaine with 75 mcg buprenorphine (Group B). The onset, maximum level and duration of sensory and motor blockade and hemodynamic parameters were monitored.</p><p class="abstract"><strong>Results:</strong> Maximum height of sensory block was achieved faster in fentanyl group (i.e. 4.09±1.12 minutes compared to 4.56±1.21 minutes in buprenorphine group). Duration of analgesia was significantly prolonged in buprenorphine group. It was 317±54 minutes and 214±35 minutes respectively for buprenorphine and fentanyl groups.</p><p class="abstract"><strong>Conclusions:</strong> The study thus concluded that although fentanyl produce faster sensory block, duration of analgesia is longer with buprenorphine, and both the drugs do not cause significant side effects.</p>

Opioid Pharmacology

2008 ◽  
Vol 2s;11 (3;2s) ◽  
pp. S133-S153 ◽  
Author(s):  
Andrea M. Trescot
Keyword(s):  
Side Effects ◽  
Pain Treatment ◽  
Volume Of Distribution ◽  
Opiate Withdrawal ◽  
Pharmacokinetic Parameters ◽  
Intractable Pain ◽  
Advantages And Disadvantages ◽  
Withdrawal Syndromes ◽  
The Individual ◽  
Mu Agonists

Background: Mu agonists have been an important component of pain treatment for thousands of years. The usual pharmacokinetic parameters (half-life, clearance, volume of distribution) of opioids have been known for some time. However, the metabolism has, until recently, been poorly understood, and there has been recent interest in the role of metabolites in modifying the pharmacodynamic response in patients, in both analgesia and adverse effects. A number of opioids are available for clinical use, including morphine, hydromorphone, levorphanol, oxycodone, and fentanyl. Advantages and disadvantages of various opioids in the management of chronic pain are discussed. Objective: This review looks at the structure, chemistry, and metabolism of opioids in an effort to better understand the side effects, drug interactions, and the individual responses of patients receiving opioids for the treatment of intractable pain. Conclusion: Mu receptor agonists and agonist-antagonists have been used throughout recent medical history for the control of pain and for the treatment of opiate induced side effects and even opiate withdrawal syndromes. Key words: Opioid metabolism, opioid interactions, morphine, codeine, hydrocodone, oxycodone, hydromorphone, methadone, intractable pain, endorphins, enkephalins, dynorphins, narcotics, pharmacology, propoxyphene, fentanyl, oxymorphone, tramadol

scholarly journals Efficacy of an Intrathecal Multidrug Infusion for Pain Control in Older Adults and in End-Stage Malignancies: A Report of Three Cases

2015 ◽  
Vol 20 (3) ◽  
pp. 118-122 ◽  
Author(s):  
Sadegh Abdolmohammadi ◽  
Pierre-Olivier Hétu ◽  
Andrée Néron ◽  
Gilbert Blaise
Keyword(s):  
Older Adults ◽  
Side Effects ◽  
Infusion Pump ◽  
Intractable Pain ◽  
Percutaneous Approach ◽  
Analgesic Medication ◽  
Lumbar Area ◽  
Alternative Modality ◽  
Bed Sores ◽  
End Stage

The aim of the present study was to explore the effectiveness of an alternative method to manage pain based on a time-limited intrathecal (IT) infusion of an analgesic medication mixture. Three patients (69, 64 and 94 years of age) with intractable and poorly controlled pain due to bed sores, pelvic metastatic mass, and thoracic vertebra and rib fractures, respectively, were treated. Daily doses of opioids could not be increased due to side effects. An IT catheter (20 G) was placed by percutaneous approach in the lumbar area while advancing toward the thoracic region, and was then tunnelled and fixed subcutaneously. It was connected to an external infusion pump with a mixture of bupivacaine 1 mg/mL, naloxone 0.02 ng/mL, ketamine 100 μg/mL, morphine 0.01 mg/mL and clonidine 0.75 μg/mL. The starting rate was 1 mL/h. The pain was mostly controlled at a rate of <1 mL/h. Opioid consumption was reduced dramatically. The catheter was kept in place for one month in the first and third patients, and for six months in the second patient, until his death. Major side effects, such as hypotension, constipation, muscle weakness, sphincter dysfunction, and cognitive or mood deterioration, were not observed with this approach. One patient experienced a urinary tract infection followed by sepsis and meningitis, which was cured by antibiotics. The catheter was removed in this patient. IT infusion with a low-concentration multidrug mixture could be considered as an alternative modality for intractable pain relief in older adults or in malignancies.

Postoperative analgesia after radical prostatectomy with high-dose intrathecal morphine and intravenous naloxone: A retrospective review

2018 ◽  
Vol 5 (6) ◽  
pp. 331-339 ◽  
Author(s):  
Annette Rebel, MD ◽  
Paul Sloan, MD ◽  
Michael Andrykowski, PhD
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Radical Prostatectomy ◽  
Respiratory Depression ◽  
Postoperative Analgesia ◽  
Intrathecal Morphine ◽  
Major Surgery ◽  
High Dose ◽  
The Mean

Background and methods: Intrathecal opioids (ITOs) have been used for decades to control postoperative pain. Intrathecal opioid dosing is limited, however, by opioid-related side effects, most importantly respiratory depression. To overcome these limitations, we combined intrathecal morphine with a continuous intravenous (IV) postoperative naloxone infusion to control opioid-related side effects. The purpose of this study is to document the efficacy and safety of high-dose intrathecal morphine combined with postoperative naloxone infusion to provide postoperative analgesia after major surgery. After IRB approval, a retrospective chart analysis was performed on 35 patients who had a radical prostatectomy from 2004 to 2006. All patients received a single injection of ITOs before anesthesia, a typical general anesthestic, followed by naloxone infusion at 5 μg/kg/h started 1 hour post-ITOs and continued for 22 hours postoperatively. The following information was collected: patient age, height, weight, anesthesia technique/time, and dose of ITOs given. Postoperative pain relief was assessed for 48 hours using the Visual Analog Score (VAS) for pain (0, no pain; 10, worst pain), perioperative opioid use, NSAID consumption, and ability of patient to ambulate. The safety of this novel treatment was assessed with opioid-related side effects and vital signs. All data are reported as mean (SD).Results: Mean ITOs given were morphine 1.3 (0.3) mg combined with fentanyl 56 (9) μg. The intrathecal morphine dose ranged from 0.8 to 1.7 mg. The mean worst pain VAS in the first 12 hours postoperatively was only 1.0 (1.7). The first NSAID dose was given 6.6 (3.1) hours post-ITOs. The first opioid on the floor was given an average of 22.6 (14.5) hours post-ITOs. A mean of only 5.7 (12.3) morphine equivalents were required on postoperative day 1 (POD 1). On POD 2, the mean worst pain VAS was only 2.6 (2.2) with only 5.7 (6.2) morphine equivalents needed to provide pain relief. On POD 1, 25 patients required no additional opioids for their entire hospital stay. Overall, 11 of 35 patients did not require any additional postoperative opioids. Thirtyfour patients (97 percent) were able to ambulate in the first 12 hours postoperatively. No opioid-induced respiratory depression was observed. Opioid-related side effects (pruritus, nausea) were infrequent and minor.Conclusions: High-dose ITOs combined with postoperative IV naloxone infusion provided excellent analgesia for radical prostate surgery. IV naloxone infusion appeared to control opioid side effects without diminishing the analgesia. No serious adverse effects were noted.

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