Epidural methadone results in dose-dependent analgesia in cancer pain, further enhanced by epidural dexamethasone

Abstract

Background:This study was designed to evaluate the role of epidural methadone-lidocaine in cancer pain combined or not to epidural dexamethasone.Methods:In all, 72 cancer patients, 32- to 67-year-old were randomized to six groups (n=12) and prospectively studied to examine analgesia and adverse effects for 3 weeks. Patients received single-dose protocol epidural test drugs: Control group (CG) received epidural 40-mg lidocaine diluted to 10-ml volume with saline. Dexamethasone group (DG) 40-mg lidocaine plus 10-mg dexamethasone. The 2.5MetG 2.5-mg epidural methadone with 40-mg lidocaine; the 5MetG, 5-mg epidural methadone plus 40-mg lidocaine, the 7.5MetG, 7.5-mg epidural methadone plus 40-mg lidocaine and finally the 7.5Met-DexG, 7.5-mg methadone with 40-mg lidocaine and 10-mg dexamethasone.Results:Groups CG, DG and 2.5MetG were similar regarding analgesia and side effects. Patients from 5MetG and 7.5MetG took 3±1 and 5±1 days, respectively, to restart oral morphine. Patients from 7.5MetDG took 14±2 to restart oral morphine (P<0.001). Daily somnolence and appetite improved in the 7.5MetDG during 2-week evaluation (P<0.005). Fatigue improved for both DG and 7.5MetDG during 2-week evaluation (P<0.005). By the third week of evaluation, all patients were similar.Conclusions:Epidural methadone plus lidocaine resulted in dose-dependent analgesia, further improved by epidural dexamethasone, which also improved fatigue.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…277 This approach is a valuable tool to improve analgesia for patients who have pain from a variety of anatomic locations (eg, head and neck, upper and lower extremities, trunk). [278][279][280][281] However, due to the risk of catheter migration and infection risk, consider limiting the duration of use to several days.…”

Methadone versus Fentanyl in Patients with Radiation‐Induced Nociceptive Pain with Head and Neck Cancer: A Randomized Controlled Noninferiority Trial

“…When no difference between nociceptive and neuropathic pain was made, no difference in pain relief between morphine and methadone could be observed. A more recent systematic review, based on 4 RCTs published after the 2007 Cochrane review, showed no difference in effectiveness between methadone compared to other strong opioids in 2 RCTs . Two other RCTs used in this systematic review evaluated the effect of opioid rotation to methadone: in one study no conclusion on the efficacy of methadone in treatment of cancer pain could be presented due to the number of dropouts, and the other reported a decrease in pain intensity switching from morphine to methadone and a patient preference for methadone .…”

Comparison of the use of levobupivacaine with dexamethasone versus plain levobupivacaine in patients undergoing forearm surgeries under an infraclavicular block - a double-blinded randomized controlled trial

“…Dexamethasone has been added to local anesthetics, amongst numerous adjuvants, such as clonidine, buprenorphine, neostigmine, tramadol, epinephrine, which have helped, improve postoperative analgesia (Bailard et al, 2014). Clinical studies in regional anesthesia, have time and again, assessed the ef icacy of dexam-ethasone mixed with local anesthetics and instilled perineurally, including epidural (Lauretti et al, 2013;Naghipour et al, 2013) brachial plexus (Persec et al, 2014) , femoral and sciatic (Fredrickson et al, 2013) and facial and dental blocks (Jürgens et al, 2012).…”