Pain treatment on outpatient basis utilizing extradural opiates. A danish multicentre study comprising 105 patients

Abstract

Previous to October 1st, 1981, 8 major Danish anaesthesiological departments registered 105 patients treated with extradural opiates for a period of more than 7 days, partially or completely on outpatient basis. Ninety-four suffered from painful malignant diseases and 11 patients from various painful benign diseases. The mean period of treatment was 65 days (range: 7-283 days) and of these 49 days (2-266 days) as outpatients. The total number of inserted epidural catheters was 215, equivalent of an average of 2 per patient (range 1-5). Reasons for removing an extradural catheter were injection-related pain, difficulty in injecting the desired volume, and displacement of catheter. Morphine chloride, in a solution of 0.4 mg/ml of normal saline, was the main choice as analgesic agent (90 patients). The mean daily dose of this drug totalled 12.6 +/- 4.8 mg (S.D.) (range: 4-30 mg) distributed as 2.7 +/- 0.9 (S.D.) (range: 1-6) daily injections. Twelve patients were treated with buprenorphine extradurally. Satisfactory pain relief was achieved for 70 patients (67%) who managed with extradural opiates as sole analgesic treatment. One patient developed septicaemia with a non-fatal outcome probably originating from some other focus. Apart from this no serious side effects were reported. Medically unskilled persons or relatives were responsible for instillation of all extradural opiates with 42 patients and partially responsible with 14 patients. Eleven patients managed injections without assistance. District nurses took care of medication for 46 patients, aided by a general practitioner in 5 cases. Three patients were supplied with continuous extradural infusion by means of a Mill Hill microinfusion pump.

Long-term spinal analgesic delivery: A review of the preclinical and clinical literature

“…There are three studies in the literature using intermittent bolusing of morphine. Crawford et al 87 reported the first series of long-term epidural morphine therapy by intermittent bolusing. Their series consisted of 105 patients (94 cancer and 11 noncancer), with a mean follow-up of 65 days.…”

Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

“…We excluded five of these papers (Figure 1), three [6-8] because they were of short duration, one [9] had no denominator, and one [10] provided information on only 30 patients. Only three [2,11,12] of the 12 remaining studies were identified by electronic searches, and nine [1,13-20] were found from reference lists. One study [17] with 110 patients included 30 with subarachnoid injections, but no deep infections; because the numbers of subarachnoid injections were tiny compared with the total number of patients in the review, we included it.…”

The use of epidural morphine at a palliative care centre

“…17 Epidural opioids have been used for periods greater than six months. 13,14,17,20,22,31 Practical aspects For the present day anaesthetist the introduction of an epidural catheter is straightforward. It is inexpensive and can be performed on the ward.…”

“…7 labour8 and myocardial ischaemic pain.9 In cancer pain there are numerous reports of use both in hospital 10--14 and at home. [13][14][15][16][17][18] Spinal opioids have not been widely used in the treatment of cancer pain at palliative care centres in the UK, possibly because few palliative care doctors are familiar with this method. Furthermore, hospice policy encourages a 'low tech-high touch' approach to patient care.…”