Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer

Gilmer-Hill, Holly; Boggan, James E.; Smith, Karen; Frey, Charles F.; Wagner, Franklin C.; Hein, Larry

doi:10.1016/s0090-3019(98)00079-2

Cited by 25 publications

(8 citation statements)

References 21 publications

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“…Invasive treatment methods (preferably subcutaneous or intravenous application of opioids, if necessary application near the spine) can be indicated if pain cannot be sufficiently controlled using the WHO-pain ladder [275].…”

Section: Recommendationmentioning

confidence: 99%

S3-Guideline “Exocrine Pancreatic Carcinoma” 2007

Adler¹,

Seufferlein²,

Bischoff³

et al. 2008

Z Gastroenterol

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Section: Recommendationmentioning

confidence: 99%

S3-Guideline “Exocrine Pancreatic Carcinoma” 2007

Adler¹,

Seufferlein²,

Bischoff³

et al. 2008

Z Gastroenterol

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“…The cancer involvement of the celiac plexus and celiac ganglions results in intractable pain, and medical treatment is often unsuccessful [17]. Thus new techniques including celiac plexus block [17, 20, 21], intrathecal morphine administration via a subcutaneous pump [22], or thoracoscopic splanchnicectomy [23] have been developed. However complete pain relief is difficult to achieve.…”

Section: Discussionmentioning

confidence: 99%

Extended Distal Pancreatectomy with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer: A Case Report and Review of the Literature

Alizai

Mahnken

Klink

et al. 2012

Case Reports in Medicine

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Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver.

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“…59,65 Interestingly, high thoracic epidural anesthesia significantly improved angina in patients with refractory pain as a result of coronary artery disease and decreased documented episodes of cardiac ischemia as judged by ST-segment depression. Acute or chronic epidural drug delivery alleviates visceral pain in patients with malignant disorders and in some patients with benign disorders.…”

Section: Epidural Analgesia and Visceral Painmentioning

confidence: 99%