The use of epidural morphine at a palliative care centre

Abstract

Four cases are reported where pain control was achieved with epidural morphine after failure with oral morphine. The indications were unacceptable adverse effects with oral morphine or morphine resistant pain. The rationale for the use of the epidural route is discussed. We believe that there is a place for epidural analgesia in selected patients at palliative care centres. Nurses need training in epidural drug administration to enable them to be involved in this form of treatment.

Keywords

analgesia bupivacaine epidural space morphine neoplasms pain

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References

Wang JK , Naus LA , Thomas JE Pain relief by intrathecally applied morphine in man. Anesthesiology 1979; 50: 149-51.

Benedetti C. Intraspinal analgesia: an historical overview . Acta Anaesthesiol Scand 1987; 31 (suppl 85): 17-24.

Bromage PR , Camporesi E. , Chestnut D. Epidural narcotics for postoperative analgesia. Anesth Analg 1980; 59: 473-80.

Stenseth R. , Sellevold O. , Breivik H. Epidural morphine for postoperative pain: experience with 1085 patients . Acta Anaesthesiol Scand 1985; 29: 148-56.

Zenz M. , Piepenbrock S. , Tryba M. , Bramswig H. Peridurale opiat-analgesie. Anesthesist 1983 ; 32: 289-94.

Rawal N. , Sjostrand UH , Dahlstrom B. Postoperative pain relief by epidural morphine. Anesth Analg 1981; 60: 726-31.

Magora F. , Olshwang D. , Eimerl D. et al. Observations on extradural morphine analgesia in various pain conditions. Br J Anaesth 1980; 52: 247-52.

Brookshire GL , Shnider SM , Abboud TK et al. Effects of naloxone on the mother and neonate after intrathecal morphine for labour analgesia . Anesthesiology 1983; 59: A417.

Pasqualucci V. Advances in the management of cardiac pain. In: Benedetti C , Chapman RC , Moricca G eds, Advances in pain research and therapy, Volume 7, Recent advances in the management of pain, New York: Raven Press, 1984: 501-20.

10.

Ventafridda V. , Figliuzzi M. , Tamburini M. et al. Clinical observation on analgesia elicited by intrathecal morphine in cancer patients. In: Bonica JJ et al., Advances in pain research and therapy, Volume 3, New York: Raven Press, 1979: 559-65.

11.

Behar M. , Olshwang D. , Magora F. , Davidson JT Epidural morphine in treatment of pain. Lancet 1979; i: 527-28.

12.

Howard RP , Milne LA , Williams NE Epidural morphine in terminal care. Anaesthesia 1981; 36: 51-53.

13.

Arner S. , Rawal N. , Gustafsson LL Clinical experience of long-term treatment with epidural and intrathecal opioids - a nationwide survey. Acta Anaesthesiol Scand 1988; 32: 253-59.

14.

Crawford ME , Andersen HB , Augustenborg G. et al. Pain treatment on outpatient basis utilizing extradural opiates. A Danish multicentre study comprising 105 patients . Pain 1983; 16: 41-47.

15.

Zenz M. , Schappler-Scheele B. , Neuhaus R. et al. Long term peridural morphine analgesia in cancer pain. Lancet 1981; i: 91.

16.

Ahlgren Fih , Ahlgren Mbe. Epidural administration of opiates by a new device. Pain 1987; 31: 353-57.

17.

Gove LF , Gordon NH et al. Pre-filled syringes for self-administration of epidural opiates . Pharmaceutical Journal 1985; 378-379.

18.

Malone BT , Beye R. , Walker J. Management of pain in the terminally ill by administration of epidural narcotics . Cancer 1985; 55: 438-40.

19.

Coombs DW Intraspinal narcotics for intractable cancer pain. In: Abram SE ed, Cancer pain, Boston: Kluwer Academic Publishers, 1989: 77-96.

20.

Ventafridda V. , Spoldi E. , Caraceni A. , de Conno F. Intraspinal morphine for cancer pain. Acta Anaesthesiol Scand 1987; 31 (suppl 85): 47-53.

21.

Cherry DA , Gourlay GK The spinal administration of opioids in the treatment of acute and chronic pain: bolus doses, continuous infusion, intraventricular administration and implanted drug delivery systems. Palliative Medicine 1987; 1: 89-106.

22.

Van Lee A. Epidural morphine in the terminally ill: how long and how high? Pain Clinic 1986; 1: 69-70.

23.

Fisher AP , Simpson D. , Hanna M.

A role for epidural opioid in opioid-insensitive pain?

Pain Clinic 1987; 1: 233-36.

24.

Tanelian DL , Cousins MJ Combined neurogenic and nociceptive pain in a patient with Pancoast tumour managed by epidural hydromorphone and oral carbamazepine. Pain 1989; 36: 85-88.

25.

Moulin DE , Coyle N.

Spinal opioid analgesics and local anesthetics in the management of chronic cancer pain. J Pain Symp

Man 1986; 1: 79-86.

26.

Scher HI , Yagoda A. Bone metastases: pathogenesis, treatment and rationale for use of resorption inhibitors. Am J Med 1987; 82 (Suppl 2A): 6-28.

27.

Bezon HT Epidural steroid injections for low back pain and lumbosacral radiculopathy . Pain 1986; 27: 277-95.

28.

Editorial. Spinal opiates revisited. Lancet 1986; i: 655.

29.

Kiss IE , Simini B. , May JW Effect of epidural morphine on various kinds of cancer pain. Palliative Medicine 1989; 3: 217-21.

30.

Glynn CJ , Jamous MA , Teddy PJ , Moore RA , Lloyd JW Role of spinal noradrenergic system in transmission of pain in patients with spinal cord injury. Lancet 1986; ii: 1249-50.

31.

Cousins MJ , Mather LE Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 276-310.

32.

Yaksh TL Spinal opiate analgesia: characteristics and principles of action . Pain 1981; 11: 293-346.

33.

Cherry DA Drug delivery systems for epidural administration of opioids. Acta Anaesthesiol Scand 1987; 31 (suppl 85): 54-59.

34.

Ottesen S. Omsorg for alvorlig syke og doende. En trearsrapport fra en radgivningsgruppe . Tidsskr Nor Laegeforen; 1989; 109: 1645-48.

35.

Barkas G. , Duafala ME

Advances in cancer pain management: a review of patient-controlled analgesia. J Pain Symp

Man 1988; 3: 150-60.

36.

Leykin Y. , Rudik V. , Niv D. , Geller E. Delayed respiratory depression following extradural injection of morphine . Isr J Med Sci 1985; 21: 855-57.