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[Intrathecal morphine therapy in children with cancer]
M Meignier1, M F Ganansia, C Lejus
1Département d'Anesthésiologie, Nantes.
Insights
Continuous intrathecal morphine or fentanyl with bupivacaine provided effective pain relief for children with advanced cancer pain when oral treatments failed. Urinary retention was the only observed side effect.
Area of Science:
- Palliative Care
- Pediatric Oncology
- Pain Management
Context:
- Advanced cancer pain in children poses significant challenges.
- Previous oral and epidural morphine treatments were ineffective.
- Home-based care with multidisciplinary support was provided.
Purpose:
- To evaluate the efficacy and safety of continuous intrathecal opioid and bupivacaine infusion in pediatric cancer patients with refractory pain.
Summary:
- Five children with refractory cancer pain received continuous intrathecal morphine or fentanyl combined with bupivacaine.
- Doses ranged from 0.1-1 mg/kg/day for morphine, up to 0.1 mg/kg/day for fentanyl, and up to 1 mg/kg/day for bupivacaine.
- Satisfactory analgesia was achieved in all patients until death, with urinary retention as the sole side effect.
Impact:
- Intrathecal opioid and bupivacaine therapy can be a viable option for managing refractory cancer pain in children.
- This treatment may be indicated when conventional oral morphine therapy fails.
- Highlights the potential for effective pain management in pediatric palliative care.
Abstract:
Five children with cancer pain were given continuous intrathecal morphine or fentanyl infusion associated with bupivacaine 0.25% without epinephrine. The morphine daily dose varied from 0.1 mg.kg-1 to 1 mg.kg-1, the maximum daily dose of fentanyl was 0.1 mg.kg-1 associated with the same dose of intravenous fentanyl, and the maximum daily dose of bupivacaine was 1 mg.kg-1. Intrathecal treatment was started after oral and epidural morphine treatment had failed. The children were at home, under the care of several nurses and physicians. A satisfactory analgesia was achieved until demise occurred. In all children, urinary retention was the only side effect of the therapy. Therefore, intrathecal opioid and bupivacaine may be indicated after oral morphine therapy has failed in children with advanced cancer refractory pain.
