Titre du document / Document title

Intrathecal coadministration of bupivacaine diminshes morphine dose progression during long-term intrathecal infusion in cancer patients

Auteur(s) / Author(s)

VAN DONGEN R. T. M. ⁽¹⁾ ; CRUL B. J. P. ⁽¹⁾ ; VAN EGMOND J. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Pain Treatment, Institute for Anesthesiology, University of Nijmegen, Sint Radboud Hospital, Nijmegen, PAYS-BAS

Résumé / Abstract

Objective: To determine the difference in intrathecal morphine dose progression between a continuous intrathecal infusion of a morphine/bupivacaine mixture and morphine for pain relief in patients with cancer. Design: Patients were treated with intrathecal drugs in a randomized study and followed prospectively until death. Setting: Institute for Anesthesiology, Department of Pain Treatment, University Hospital Nijmegen, St Radboud, The Netherlands. Patients: Twenty patients with cancer were selected for intrathecal treatment because of either side effects or inadequate relief during conventional pain treatment. Interventions: Intrathecal drug infusion rates and medication were adjusted according to pain relief and side effects. Outcome Measures: Progression of intrathecal morphine dose during a phase of adequate analgesia in both groups following regression analysis and analysis of possible treatment related side effects. Results: The combination of intrathecal morphine and bupivacaine resulted in a diminished progression of the intrathecal morphine dose (slope of regression line = 0.0003 vs. 0.005, p = 0.0001) during a phase of stable analgesia in comparison with the morphine group. No serious side effects presented. Conclusion: The diminished intrathecal morphine dose increase in the combination group is considered to be due to a synergistic effect of bupivacaine on the intrathecal morphine-induced antinociception. A dose increment during long-term intrathecal infusion in cancer patients appears to be related to both disease progression and tolerance phenomena.

Revue / Journal Title

The Clinical journal of pain   ISSN 0749-8047   CODEN CJPAEU 

Source / Source

1999, vol. 15, n^o3, pp. 166-172 (27 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams and Wilkins, Hagerstown, MD, ETATS-UNIS  (1985) (Revue)

Mots-clés anglais / English Keywords

Malignant tumor ; Pain ; Morphine ; Narcotic analgesic ; Bupivacaine ; Local anesthetic ; Intrathecal administration ; Chemotherapy ; Combined treatment ; Human ; Perfusion ; Long term ; Opiates ; Anilide ; Organic amide ; Posology ; Route of administration ;

Mots-clés français / French Keywords

Tumeur maligne ; Douleur ; Morphine ; Analgésique narcotique ; Bupivacaïne ; Anesthésique local ; Voie intrarachidienne ; Chimiothérapie ; Traitement associé ; Homme ; Perfusion ; Long terme ; Opiacés ; Anilide ; Amide organique ; Posologie ; Voie administration ;

Mots-clés espagnols / Spanish Keywords

Tumor maligno ; Dolor ; Morfina ; Analgésico narcotico ; Bupivacaína ; Anestésico local ; Vía intraraquídea ; Quimioterapia ; Tratamiento asociado ; Hombre ; Perfusión ; Largo plazo ; Opiados ; Anilido ; Amida ; Posología ; Vía administración ;

Localisation / Location

INIST-CNRS, Cote INIST : 20743, 35400008819311.0010