Effective intrathecal opioid analgesia in two patients refractory to high doses of systemic opioids

Ota, Shuhei; Ogawa, Kenichi; Shinbori, Hironobu; Harada, Shigenori; Hata, Chiaki; Goto, Takahisa

doi:10.2512/jspm.4.317

Cited by 1 publication

(3 citation statements)

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“…This technique may therefore be very useful in decreasing the side‐effects of systemic opioids. Given that subarachnoid bupivacaine infusion has been proven to be very effective for neuropathic pain, it is often used in combination with morphine . In the present patient, combination therapy effectively decreased malignancy‐related pain and reduced the severe side‐effects of systemic opioids.…”

Section: Discussionmentioning

confidence: 95%

“…Given that palliative care is becoming a more pressing issue, even in the pediatric field, subarachnoid continuous drug infusion may constitute an additional method of pain management. Regarding drug dosage, the effect of systemic opioid treatment can be achieved with as little as 1% of the dose via subarachnoid infusion . This technique may therefore be very useful in decreasing the side‐effects of systemic opioids.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, subarachnoid continuous infusion of analgesics is excellent in controlling pain with comparatively fewer adverse effects than systemic treatment . In adults, subarachnoid infusion is used not only in surgical treatment, but also for controlling cancer pain via a device called a patient‐controlled analgesia (PCA) pump, especially in home‐based palliative care .…”

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confidence: 99%

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Effectiveness of subarachnoid drug infusion for pediatric tumor‐related pain

Higuchi

Shimada

Cho

et al. 2016

Pediatrics International

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Although the effectiveness of subarachnoid continuous drug infusion has been established in cancer pain management, its clinical use in children is rare. A 14-year-old girl with neurofibromatosis type I complained of right leg pain stemming from a growing tumor on her right buttock. Continuous and breakthrough right leg pain were unbearable, even at high doses of systemic opioids that caused severe constipation and deep sedation. Subsequent continuous infusion of bupivacaine and morphine through a subarachnoid catheter effectively relieved the girl's pain. The corresponding decrease in systemic opioid also improved her activities of daily living. The patient eventually died of cachexia due to the rapidly growing buttock lesion that was pathologically confirmed post-mortem as a malignant peripheral nerve sheath tumor. Subarachnoid continuous drug infusion may be very useful in controlling severe pain with few side-effects, even in the field of pediatric palliative care.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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