Patient-controlled analgesia for chronic cancer pain in the ambulatory setting: a report of 117 patients.

Abstract

Patient-controlled analgesia (PCA) represents a drug-delivery system in which patients self-administer predetermined doses of opiate analgesics. We have taken advantage of recent advances in pump technology and developed a system in which patients with severe pain received a continuous narcotic infusion, along with the capability of PCA bolus for breakthrough pain. All patients were experiencing chronic pain related to cancer and were unable to obtain adequate pain control with either intermittent parenteral, oral, or rectal narcotics. Sixty-nine percent of patients were treated in the home setting, and the majority received morphine sulfate subcutaneously (SQ). Admixture stability studies using high-pressure liquid chromatography (HPLC) showed that dexamethasone, metoclopramide, and haloperidol could be added to the morphine solutions and remain stable for 1 week at room temperature. Of 117 patients entered, 95% received excellent pain control, and side effects were rare, consisting of subcutaneous needle site infection and respiratory depression. Progressive pain due to either advancing disease or development of drug tolerance could be controlled by increasing opiate infusion rates. We conclude that (1) continuous infusion opiate with PCA bolus capability can be initiated and administered safely in the home setting; (2) patients with pain related to malignancy can be managed well with this system; and (3) pain control programs can be designed, implemented, and evaluated in the private practice setting.

Ketamine patient-controlled analgesia for dysesthetic central pain

“…1,5,25 However, in chronic malignant pain, which tends to be more progressive and steady than postsurgical pain, basal infusions are routinely administered in outpatient settings. 26,27 Given that our patient's condition was more akin to the former than the latter, her pain was constant and unrelenting, and the sequelae of overmedicating with opioids are more catastrophic than with ketamine, we elected to use a basal rate.…”

Häusliche Behandlung von Tumorschmerzpatienten mit patientenkontrollierter Analgesie (PCA)

“…Auch wenn die Regeln des WHO-Stufenschemas zur Tumorschmerztherapie beachtet werden und bei Unmöglichkeit der oralen Zufuhr alternative Wege der Schmerzmittelapplikation wie transkutane Therapiesysteme und die bukkale oder nasale Opioidzufuhr genutzt werden, ist bei einem Teil der Tumorschmerzpatienten eine parenterale Schmerztherapie unumgänglich [5,9,10,11,12].…”

“…transkutanen Medikamentengabe auf ein PCA-System bei 94 von 108 Patienten zu einer prompten und anhaltenden Schmerzreduktion. Ähnli-che Ergebnisse zeigten sich in einer Arbeit von Schiessl et al [11], in der 846 Patienten über 1692 Behandlungstage beobachtet wurden, bei Swanson et al [12] mit einer durchgehenden Reduktion der Schmerzen von "severe" auf "mild" sowie bei Meuret u. Jocham [10], die bei 2 Dritteln der Patienten eine exzellente und bei 30% eine befriedigende Analgesie erreichten.…”

Patientenkontrollierte Analgesie (PCA) bei ambulanten Tumorschmerzpatienten

“…Originalien Die meisten Patienten im fortgeschrittenen Stadium einer inkurablen Erkrankung möchten im häuslichen Umfeld sterben [13,19,25]. Nicht selten scheinen diesem Wunsch "therapieresistente" Schmerzen oder die Notwendigkeit qualifizierter palliativmedizinischer Betreuung mit Hospitalisation entgegenzustehen [12,18,27].…”