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Intrathecal therapy: rationale, technique, clinical results
J L Madrid1, L V Fatela, R D Lobato
1Pain Unit, Hospital 1 de Octubre, Madrid, Spain.
Acta Anaesthesiologica Scandinavica. Supplementum
|January 1, 1987
Summary
A new subcutaneous injection port effectively delivered intrathecal morphine for cancer pain relief in 35 patients. This cost-effective reservoir allowed for home-based treatment with minimal side effects, offering an alternative to expensive devices.
Area of Science:
- Oncology
- Pain Management
- Neurosurgery
Background:
- Cancer pain significantly impacts patient quality of life.
- Intrathecal drug delivery offers targeted pain relief.
- Existing intrathecal devices can be costly and complex.
Purpose of the Study:
- To evaluate the efficacy and safety of a subcutaneously implanted injection port/reservoir for intrathecal morphine delivery.
- To assess the feasibility of home-based administration by family members.
- To present an alternative to expensive intrathecal drug delivery systems.
Main Methods:
- A cohort of 35 cancer patients received intrathecal morphine via a subcutaneously implanted port/reservoir.
- Patients or their family members were trained for repeated injections or infusions.
- Morphine dosage and pain relief duration were monitored.
- Side effects and complications, such as cerebrospinal fluid (CSF) fistula, were recorded.
Main Results:
- The injection port/reservoir provided effective pain relief for 14-24 hours with initial doses of 0.25-0.5 mg morphine.
- Morphine requirements increased to 0.75-2 mg after 5 weeks of treatment.
- Side effects were minimal.
- Three cases of delayed CSF fistula occurred, with two confirmed by isotope tracking; all closed spontaneously.
Conclusions:
- Subcutaneously implanted injection ports are a viable, cost-effective option for intrathecal morphine delivery in cancer pain management.
- Home administration by trained family members is feasible, facilitating ambulatory treatment.
- This method offers an accessible alternative to more expensive intrathecal devices with a favorable safety profile.