Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer

Ballantyne, Jane C.; Carwood, Caroline M.; Gupta, Anita; Bennett, Michael I.; Simpson, Karen H.; Dhandapani, Karthikeyan; Lynch, Louise; Baranidharan, Ganesan

doi:10.1002/14651858.cd005178

Cited by 81 publications

(30 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent systematic review of efficacy of epidural, subarachnoid, and intracerebroventricular opioids for cancer pain [21] had information on 2,402 patients in 72 uncontrolled studies reporting on efficacy. It found eight spinal infections, without detailed description, in 154 patients (5.2%).…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, the present systematic review concentrated on reports of epidural infection, and found 57 cases of deep epidural infection in 4,628 patients (1.2%) in 12 uncontrolled studies. In comparing these two approaches, only one study (published as an abstract) included in the Ballantyne & Carwood review [21] was missed by our approach, and that reported only a single superficial infection in 129 patients. Several studies included in this review may have been eligible for that of Ballantyne & Carwood.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

et al. 2007

View full text Add to dashboard Cite

BackgroundTo determine infection rate with use of epidural catheters in place for seven days or more.MethodsSystematic review and pooled analysis of observational studies.ResultsTwelve studies with 4,628 patients (median 197 patients) provided information, of which nine (4,334 patients) were published after 1990. Eight studies (3,893 patients) were retrospective, and four studies (735 patients) prospective. Electronic searches identified three studies and searching reference lists nine.There were 257 catheter-related infections in total, of which 211 were superficial and 57 deep, giving rates of 6.1%, 4.6% and 1.2% respectively. Ten of the 12 studies had deep infection rates of 2% or less. The incidence of deep infection was 1 per 2391 days of treatment, or 0.4 per 1000 catheter treatment days. In nine studies (1503 patients), predominantly in cancer, and with average catheter duration of 74 days, the deep infection rate was 2.8%. The proportion of patients with infection of any type was higher in cancer patients with longer catheter duration. Limited numbers of events meant that no reliable estimate of the impact of prospective and retrospective design could be made. There appeared to be a relationship between catheter duration and infection rate from this and other recent estimates. Four of 57 (7%) patients with deep infection died.ConclusionThe best estimate is that one person in 35 with an epidural catheter in place for 74 days for relief of cancer pain can be expected to have a deep epidural infection, and that about 1 in 500 may die of infection-related causes. This is a most uncertain estimate given the limited nature of the evidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

et al. 2007

View full text Add to dashboard Cite

show abstract

“…With respect to cancer pain, a Cochrane review published in 2005 included one randomized controlled trial (RCT) comparing intrathecal morphine with conventional delivery of morphine in patients with cancer pain 39. The success rate of intrathecal delivery was 85% compared with 71% for that of conventional drug delivery.…”

Section: Efficacymentioning

confidence: 99%

Current perspectives on intrathecal drug delivery

Bottros¹,

Christo²

2014

JPR

View full text Add to dashboard Cite

Advances in intrathecal analgesia and intrathecal drug delivery systems have allowed for a range of medications to be used in the control of pain and spasticity. This technique allows for reduced medication doses that can decrease the side effects typically associated with oral or parenteral drug delivery. Recent expert panel consensus guidelines have provided care paths in the treatment of nociceptive, neuropathic, and mixed pain syndromes. While the data for pain relief, adverse effect reduction, and cost-effectiveness with cancer pain control are compelling, the evidence is less clear for noncancer pain, other than spasticity. Physicians should be aware of mechanical, pharmacological, surgical, and patient-specific complications, including possible granuloma formation. Newer intrathecal drug delivery systems may allow for better safety and quality of life outcomes.

show abstract

“…The few prospective studies compare different routes of administration and are without placebo control. A Cochrane review published in 2005 which investigated the efficacy of epidural, subarachnoid and intracerebroventricular opioids in patients with pain due to cancer did not retrieve any controlled trials [53].…”

Section: Opioidsmentioning

confidence: 99%

Cancer Pain: Analgesics and Co‐Analgesics

Bell

2010

Evidence‐Based Chronic Pain Management

View full text Add to dashboard Cite

Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer

Cited by 81 publications

References 43 publications

Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

Current perspectives on intrathecal drug delivery

Cancer Pain: Analgesics and Co‐Analgesics

Contact Info

Product

Resources

About