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Intrathecal Morphine Delivery at Cisterna Magna to Control Refractory Cancer-Related Pain: A Prospective Cohort Study
Chang Sun1, Yu-Tong Wang1, Yu-Jie Dai1
1Dr. Sun, Department of Orthopedics, General Hospital of the PLA Airforce, Beijing, China. Liu, Yang, Zhao, Lu, Anesthesia and Operation Center, Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China. Wang, Department of Emergency, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Dai, Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Cheng, Jin, Department of Anesthesiology, Pain Medicine Center Jinling Hospital, Nanjing, China. Dong, Wang, Song, Department of Pain medicine, The First Affiliated Hospital of Chinese Medical University, China. Sun, Department of Neurology, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Prof. Sun, Department of Comprehensive treatment, the second Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China.
Background:
For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.
Methods:
Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.
Results:
Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).
Conclusions:
Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.
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