Comparison of 0.5% intrathecal bupivacaine with 0.5% intrathecal ropivacaine in the treatment of refractory cancer and noncancer pain conditions: Results from a prospective, crossover, double-blind, randomized study

Dahm, Peter; Lundborg, Christopher; Janson, Magnus; Olegård, Cecilia; Nitescu, Petre

doi:10.1053/rapm.2000.8574

Cited by 18 publications

(13 citation statements)

References 20 publications

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“…Systematic reviews, consensus conferences, and randomized controlled trials Three systematic reviews [5][6][7], three consensus conferences [8][9][10], and 12 RCTs [11][12][13][14][15][16][17][18][19][20][21][22] met the selection criteria of studies examining clinical effectiveness. Although the systematic reviews and consensus conferences included some relevant RCTs, no single systematic review or consensus conference included all relevant RCTs or sufficiently discussed the effectiveness of intraspinal analgesia for cancer-related pain to support recommendations.…”

Section: Resultsmentioning

confidence: 99%

“…Intraspinal analgesia as an intervention was addressed in a summary of RCTs evaluating adjuvant analgesics. Three of the six RCTs were relevant [17][18][19]. The review concluded insufficient RCT evidence was available to determine the relative efficacy of the spinal versus systemic route of drug administration.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

“…In a crossover RCT comparing intrathecal bupivacaine with ropivacaine (n=21), Dahm [17] showed no significant difference in pain scores but higher daily doses of local anesthetic to achieve a similar degree of pain relief were used with ropivacaine. Groups did not differ for side effects or complications.…”

Section: Comparisons Of Different Intraspinal Medicationsmentioning

confidence: 99%

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Intraspinal techniques for pain management in cancer patients: a systematic review

Myers

Chan

Jarvis

et al. 2009

Support Care Cancer

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Effectivenessmentioning

confidence: 99%

Section: Comparisons Of Different Intraspinal Medicationsmentioning

confidence: 99%

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Intraspinal techniques for pain management in cancer patients: a systematic review

Myers

Chan

Jarvis

et al. 2009

Support Care Cancer

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“…Bupivacaine can also be used as the sole agent for ITA [61,67,142]. Moreover, it has been shown that the adjunction of bupivacaine to morphine leads to a diminished dose progression of morphine, suggesting a synergetic effect [251].…”

Section: Intrathecal Analgesia In Cancer Painmentioning

confidence: 99%

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Bäckryd¹

2015

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The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain. In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question. In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor. In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses

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“…Local anesthetics are often used to alleviate pain after surgery, medical procedures and dental pains (Smith et al, 1999). They are also used in the control of postoperative pain and in the therapy of chronic pain (Dahm et al, 2000) and can be used for regional control of major pain. In relieving local pains, ropivacaine, one of local anesthetics belonging to the amide group, has been used.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Local Anesthetic Efficacy of Bioadhesive Ropivacaine Gels

Cho¹,

Shin²

2011

Biomolecules and Therapeutics

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associated with dental care (Moore, 2007). Of many drug delivery systems, percutaneous drug delivery can provide controlled delivery of drugs. However, in case of their application such as ointments and creams, it is diffi cult to expect their effects for a signifi cant period of time, because they are easily removed by wetting, movement and contacting. Therefore, the new formulations that have suitable bioadhesion were needed to enhance local anesthetic effects. Carboxymethyl cellulose (CMC) is used to control drug release from several pharmaceutical systems because of its non-toxic nature, easy compression, swelling properties, and accommodation of high levels of drug (Nairn, 2000). To formulate bioadhesive gels, we compared the viscosity and bioadhesive forces of CMC, as well as drug release as a function of temperature and drug concentration. To increase the skin permeation of ropivacaine from the CMC gels, enhancers such as saturated and unsaturated fatty acids, pyrrolidones, propylene glycol derivatives, glycerides, and the non-ionic surfactants were incorporated in the ropivacaine-CMC gels. The local an

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Comparison of 0.5% intrathecal bupivacaine with 0.5% intrathecal ropivacaine in the treatment of refractory cancer and noncancer pain conditions: Results from a prospective, crossover, double-blind, randomized study

Abstract: The results of this study do not support the hypothesis that IT infusion of 0.5% ROP has advantages over IT infusion of 0.5% BUP when administered for relief of "refractory" pain.

Cited by 18 publications

References 20 publications

Intraspinal techniques for pain management in cancer patients: a systematic review

Intraspinal techniques for pain management in cancer patients: a systematic review

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

Enhanced Local Anesthetic Efficacy of Bioadhesive Ropivacaine Gels

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